The specific amount you’ll owe may depend on several things, like:
The CPT codes used for screening mammography:
An ICD-10-CM diagnosis code(s) should be linked to the appropriate CPT mammography code reported. The proper diagnosis code to report would be Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast.
ICD-10 code Z12. 31 for Encounter for screening mammogram for malignant neoplasm of breast is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is reported for screening mammograms while Z12. 39 (Encounter for other screening for malignant neoplasm of breast) has been established for reporting screening studies for breast cancer outside the scope of mammograms.
ICD-9 Code V76. 12 -Other screening mammogram- Codify by AAPC.
Specifically, according to cms.org, CMS instructs that mammography be described using the following codes: G0202, Screening mammography, bilateral (two-view study of each breast), including CAD when performed.
Group 1CodeDescriptionZ12.31Encounter for screening mammogram for malignant neoplasm of breast
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
39 (Encounter for other screening for malignant neoplasm of breast). Z12. 39 is the correct code to use when employing any other breast cancer screening technique (besides mammogram) and is generally used with breast MRIs.
9.
When modifier 52 is appended to the screening mammography codes 77057 or G0202 and 77052, it would be assumed that the service rendered was a unilateral mammography. The unilateral mammography would be paid at a reduced rate.
Encounter for gynecological examinationZ01.411. Encounter for gynecological examination (general) (routine) with abnormal findings Use this code if pap smear is a part of a routine gynecological examination.
Applicable To. Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.
For screenings for breast cancer or cervical cancer, include a copy of the exam or results in the patient's record. This enables you to use the specified reporting code. Premera may request a copy of this record at a later date.
For colorectal cancer screenings, a copy of the report is required for the fecal immunochemical test (FIT) or fecal occult blood test (FOBT) screenings, but not for previous colonoscopies. The best practice is to retain a copy of patient's colonoscopy in the record. Premera may request a copy of this record at a later date.