Wellness

[SouthernBee]

@lovethgedress- Interesting information. Could or should this code indicate a reduced  price? Hum... Southern Bee

[SouthernBee]

@Tyak:Yea- 10 year survivor! Interesting about the diagnostic mammogram. I am normally notified within two weeks with a letter about the results. Southern Bee

[SouthernBee]

@GCR18- please laugh with me. I am short but with cerebral palsy left side shorter.  Only breast on left side . I have balance issues and walk with a cane. Try to visualize me- trying to stand up tall and plop that boob on the machine, not move or breath while they smash it- triple ouch!!! Then they tell me- I moved and need to do this again!!! That area stays red and hurts for at least 2 hours!!! Considering what I know now- should of had a double removal. Southern Bee

[HerRoyaLioness]

@SouthernBee- there should be a code for both a unilateral and a bilateral mammography, however Medicare has it's own codes for some procedures.  

A doctor would never order bilateral if they were only to do one, it is fraud and they don't want to lose their license.  They have a professional staff who do the coding and it is usually not done wrong, not to say mistakes can't be made.  Insurances confuse people and their go to comment is that it was coded wrong - not usually the case.  

You need to ask your insurance to clarify this for you, or if they can't (most times they don't know the coding part), then call the drs office and find out what was ordered, what was done and what was charged out - they can tell you exactly.

I'm not clear on why you think a bilateral mammography was charged.  Did you also have a tomography or CT scan?  Was there a modifier on theCPT code?  Do you have Medicare as a secondary insurance, what is your primary insurance?

You are correct in thinking that what was actually done is what should be coded out and charged.  Sometimes errors are made, so if you really were charged for bilateral, it should be changed.

[shoesnbags]

@SouthernBee 

As a 16 year BC survivor, I can tell you that the cost of a mammo doesn't vary according to whether it's a single or a double. It's been that way for me before I was on Medicare and after - no change. Just one of those mysteries of the Universe, I guess. And after surviving cancer most of us don't sweet the small stuff. Just happy to be around to get another yearly mammo - and to get negative results. 

[hopi]

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@SouthernBee wrote:

@hopi: My understanding - both the insurance companies , doctor offices etc- use the codes provided by the " national procedure code" . I was trying to get information from Medicare and the insurance company  on who or what group to notify them about this and to see if any changes could be made. However, I felt like from their answers that I was concerned about something that is not really a problem. Southern Bee

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@SouthernBee Maybe a good Medicare phone rep would help and a doctor that would know. Thought ABN forms had to be signed if a procedure was not covered. Mamms are usually preventative but your situation sounds so different and extreme from a normal test. Sorry am no expert in this area.

[Irish1210]

Love and blessings to all of you survivors ~ You are heroes!!   

[Carmie]

Once you have been diagnosed with cancer, all future mammograms will not be coded as preventative.

i don't agree with this, but this is how coders MUST code.

You are not alone in being upset with this.  Many women have a very high copay with diagnostic mammograms while a preventative one is paid in full.

there is no way to get this changed,  so sorry.

[HerRoyaLioness]

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@Carmie wrote:

Once you have been diagnosed with cancer, all future mammograms will not be coded as preventative.

i don't agree with this, but this is how coders MUST code.

You are not alone in being upset with this.  Many women have a very high copay with diagnostic mammograms while a preventative one is paid in full.

there is no way to get this changed,  so sorry.

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CARMIE, where did you get this information?  I am over 4 years out and back to a yearly screening for cancer mammo.  I am no longer under treatment for my breast cancer and have had over 3 years of normal, every 6 mos results now.  This is the protocol my dr uses. 

A mammo should never be coded as part of a preventive visit (annual physical).  It is separate testing.  We are talking about two different diagnosis codes, in addition to the CPT code.  

[LindaSal]

I will be a three year survivor this Christmas.  I still have to do 6 month mammograms and ultrasounds together.  I am high risk as there are other areas they are monitoring.   Luckily I am still mostly intact and just had a large lumpectomy.    I am not old enough for medicare but I have not run into any issues like this, thankfully.    I feel blessed to be here and am currently cancer free.