In simple words: If your doctor starts with a regular mammogram but finds something that needs a closer look, they might change it to a special type of mammogram called a diagnostic mammogram, all during the same visit. This means they'll look more closely at the area of concern without taking extra pictures.Modifier GH is a code used by insurance companies to know they should only pay for the special, more detailed mammogram.

Modifier GH is appended to a diagnostic mammography code when a patient presents for a screening mammogram, but due to the discovery of an abnormality during the screening, the exam is converted to a diagnostic mammogram on the same date of service. This conversion involves no additional views being taken during the exam.Medicare will only reimburse for the diagnostic mammogram, not the screening. If both screening and diagnostic mammograms are performed separately on the same day due to an abnormality, modifier GG is appended to the add-on mammography code.

Example 1: A patient arrives for a routine screening mammogram. During the exam, the radiologist notices a suspicious area.The radiologist converts the screening mammogram into a diagnostic mammogram to investigate further, without taking additional images. Modifier GH is appended to the diagnostic mammogram code., A patient has dense breast tissue and is scheduled for a screening mammogram. During the screening, a concerning density is detected.To get a clearer view, the exam is changed to a diagnostic mammogram within the same appointment, with no additional views. The diagnostic mammogram is coded with modifier GH., A patient feels a lump in her breast and schedules a screening mammogram. Upon initial imaging, the radiologist decides a more detailed view is necessary to assess the lump. The radiologist converts the screening mammogram to a diagnostic mammogram during the same visit without additional views. The claim is submitted with the diagnostic mammogram code and modifier GH.

Documentation should clearly state the reason for the conversion from screening to diagnostic mammogram, including the initial findings that prompted the change.The medical record must reflect that no additional views were taken beyond the initial screening images.