CMS Holds to Screening/Diagnostic NCCI Edits

CMS has turned down the American College of Radiology’s request to delete the newly implemented NCCI edits for screening and diagnostic mammography performed on the same patient on the same date of service. Writing on behalf of CMS, Niles Rosen, medical director of the National Correct Coding Initiative (NCCI), announced in a March 17, 2015, letter that CMS has decided to retain its current policy regarding the use of screening/diagnostic mammography NCCI edits. According to that policy, a provider, who performs both screening and diagnostic mammography on the same patient on the same date of service, is required to report modifier GG with the diagnostic mammography code (77055, 77056, G0204, or G0206). However, modifier GG is not an NCCI-associated modifier and will not bypass the NCCI edit. Therefore, providers are instructed to additionally append modifier 59 (Distinct Procedural Service) to the screening mammography code (77057 or G0202) to bypass these edits.