CPT code 76091 is used for a diagnostic procedure involving a mammogram of both breasts to detect abnormalities or changes in breast tissue.
CPT code 76091 is used to describe a diagnostic mammogram procedure that involves imaging both breasts. This code is typically utilized when a patient requires a more detailed examination of breast tissue, often following an abnormal screening mammogram or when there are specific symptoms or concerns that need further investigation. The procedure involves taking multiple X-ray images of each breast to help detect any abnormalities or changes in breast tissue.
When dealing with CPT codes 76090 and 76091, it's important to consider the appropriate use of modifiers to ensure accurate billing and reimbursement. Here is a list of potential modifiers that could be applied:
1. Modifier 26 (Professional Component): This modifier is used when the professional component of the service is being billed separately from the technical component. It indicates that the service provided was the interpretation of the mammogram, not the actual performance of the imaging.
2. Modifier TC (Technical Component): This modifier is used when the technical component of the service is being billed separately from the professional component. It indicates that the service provided was the performance of the imaging, not the interpretation.
3. Modifier 52 (Reduced Services): This modifier may be used if the mammogram was partially completed or if the service was reduced at the discretion of the healthcare provider. It indicates that the full service was not provided.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the mammogram needs to be repeated on the same day by the same physician due to technical issues or other valid reasons.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if the mammogram needs to be repeated on the same day by a different physician.
6. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the mammogram was a distinct service from other procedures performed on the same day. It helps to prevent bundling of services that should be billed separately.
7. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Although not typically used for imaging, this modifier might be applicable if the mammogram is repeated for clinical reasons, not due to a technical issue.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the payer to ensure compliance and proper reimbursement. Always verify with the latest payer policies and coding guidelines to ensure correct application.
CPT code 76091 is not reimbursed by Medicare. This code was previously used for certain procedures but has since been replaced or deemed non-reimbursable under the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult the current MPFS for updated information on reimbursable services.
Additionally, it is advisable to verify with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or updates regarding reimbursement policies for similar services.
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