A: It is only appropriate to bill for a consultation or other evaluation and management (E/M) service when the service is provided and documented according to established E/M guidelines. For breast interventional procedures, a brief review of history and physical exam and obtaining informed consent is not a separately reportable E/M service. This service is considered bundled into the surgical procedure code.
Click here for a copy of the documentation guidelines. The E/M guidelines are currently under review. Until the E/M documentation guidelines are finalized, it is up to the provider to use either the 1995 or 1997 published guidelines. It is recommended, however, that for auditing purposes a radiology practice use one set of guidelines, ie, either 1995 or 1997.
A: According to the 黑料网's Standard for Diagnostic Mammography, a diagnostic mammogram should be performed on patients with augmented breasts. However, the Centers for Medicare and Medicaid Service's (CMS, formerly known as HCFA) payment policy for a diagnostic mammogram does not recognize asymptomatic patients with augmented breasts as diagnostic. Medicare will only pay for a screening mammogram for an asymptomatic woman with breast implants.
Since Medicare denies the necessity of a diagnostic mammogram for an asymptomatic patient with augmented breasts, an advance beneficiary notice (ABN) should be obtained from the patient if the radiologist plans to bill the patient for a diagnostic mammogram. If the patient and referring physician decide that a screening mammogram should be performed, then the patient would receive a screening mammogram.