The annual statistics from 2019 to 2022 indicate that between 39 and 40 million mammograms are performed annually. Despite the procedure’s widespread use, we are aware of the difficulties and complexities it presents for medical billing.
When abnormalities or questionable findings are found during a routine screening mammography, healthcare providers frequently append the GG modifier. This is the topic of today’s blog. Let’s investigate the most accurate method for billing the GG modifier.
GG Modifier – Description
The GG modifier is an HCPCS Level II modifier used for a screening mammography service that was changed to a diagnostic mammography treatment during the same patient visit. Its official description says:
“Performance of a screening mammogram and a diagnostic mammogram on the same patient, same day.”
This modifier is appended when abnormalities or questionable results are found during a regular screening mammography. The patient does not need to make an appointment for the radiologist to perform diagnostic views, magnification imaging, or extra breast exams. This modifier is appended to clarify to insurance payers that further diagnostic imaging became medically necessary after the first screening process began. Hence, both procedures should be reimbursed.
An Appropriate Use Case for GG Modifier
The following is a real-life example illustrating when a second diagnostic mammography is required and when providers should apply the GG modifier.
Abnormal Finding During Routine Screening
Suppose a patient shows up for a routine screening mammogram without any symptoms, and the radiologist finds a worrisome tumor, calcification, or abnormal tissue pattern during the screening. He performs another diagnostic mammography to confirm the results.
The provider adds the GG modifier to indicate that after the preventive screening, a diagnostic evaluation was performed during the same visit to rule out or confirm abnormalities.
Accurate Usage Guidelines for GG Modifier
The following are some billing guidelines that you must follow to append the GG modifier to your claims.
Use the Modifier Accurately
Accurate billing requires understanding the precise application of each modifier. When a radiologist performs screening and diagnostic mammography on the same patient on the same day, modifier GG is correctly applicable. However, the medical need for the diagnostic mammography must be an unexpected abnormal finding during the preventive screening.
Also, you cannot apply this modifier to the claim if the patient returns for diagnostic imaging on a separate date.
Apply with Diagnostic Codes
Another way to bill this modifier accurately is by appending it to the correct diagnostic mammography procedure code. This modifier is commonly appended with CPT codes: 77065 and 77066.
The reason is that appending GG to these CPT codes facilitates insurance payers’ understanding that the diagnostic imaging was the result of a same-day screening assessment.
Include Documentation
Documents play a major role in medical billing. Why? Because supporting documents establish the medical necessity of the service.
Hence, to submit accurate claims, medical coders and billing professionals must ensure that the patient’s medical records are clearly documented. The paperwork must also provide valid proof of why a diagnostic procedure was required after a routine screening exam. Furthermore, you must mention radiology findings, physician recommendations, and the medical decision-making that followed.
Avoid Inappropriate Usage of Modifier GG
Let’s talk about a few incorrect applications of the GG modifier before we wrap up.
It is important to avoid using this modifier with a scheduled diagnostic mammography. This modifier should not be used if the diagnostic mammography was planned from the beginning due to existing symptoms, previous abnormalities, or medical directives. It is only meant to be used in circumstances where a preventive screening suddenly turned into a diagnostic assessment within the same visit.
Final Thoughts
We hope that this detailed guide will enable you to apply the GG modifier appropriately to your claims. But before we leave, here is a summary of the key points in case you missed anything:
- You should only apply this modifier when a diagnostic mammography becomes mandatory after a screening mammography during the same patient visit.
- Modifier GG must be appended to the diagnostic mammography code and the routine screening code.
- Proper documentation is essential when using this modifier.
However, ensuring the accurate usage of the GG modifier is still complex for billers. Hence, opting for specialized medical billing and coding services from firms like NeuraBill is preferable. You can improve revenue collection and expedite turnaround times by collaborating with experts.
