decisionhealth Newsletters, Part B News - 2017 Issue 2 (February)
Inspect mammography coding policies amid reporting upheaval
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Article Overview
This article reviews a transitional mammography reporting environment in which newer CPT mammography codes, legacy HCPCS Level II G-codes, and related diagnosis coding considerations may be handled differently by Medicare and commercial payers. It is intended for radiology, billing, and coding professionals who need to understand the scope of the change, the payers involved, and the kinds of policy differences that can affect claim submission and denial management.
Why This Topic Matters
Mammography claims can be rejected or processed differently depending on payer policy during code-set transitions, so understanding the reporting landscape helps practices reduce denials and verify that their billing workflows match current payer requirements.
Article Sections
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Coding
Introduces the reporting changes affecting mammography services and explains why payer policy review is necessary during the transition year.
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Assess how payers are operating
Discusses how different payers may handle mammography claims during the transition and why practices should verify accepted reporting approaches before billing.
What You Will Learn
- How mammography reporting changed during the transition period
- Which code sets are involved in the mammography update
- Why payer policies may differ for the same service
- What types of claims-processing issues may occur during code-set changes
- How diagnosis coding remains part of the mammography claim workflow
Who Should Read This
- Medical coders
- Radiology billing staff
- Physician practice managers
- Compliance staff
- Revenue cycle teams
Codes Discussed
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