Bilateral refers to the right and left sides, or members, of a paired organ in the body. Most mammograms are ordered as bilateral, the exception being when one breast exhibits abnormalities and additional mammography views are needed 2. Men can also develop breast cancer, but it is very rare (less than 1 percent of all new breast cancers).
The CPT codes used for screening mammography: 77067 – Screening mammography, bilateral (two-view study of each breast), including computer-aided detection (CAD) when performed A diagnostic mammogram is covered by CMS if one of the following conditions exists:
CAD for mammograms is used to analyze mammographic images and check for the presence of breast cancer. The CAD system analyzes digital information collected by a mammogram and then computer software searches for abnormal areas of density, mass or breast calcification.
Group 1CodeDescription77067SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMEDC8903MAGNETIC RESONANCE IMAGING WITH CONTRAST, BREAST; UNILATERALC8905MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; UNILATERAL15 more rows
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.
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. G0204, Diagnostic mammography, including CAD when performed; bilateral.
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 .
HCPCS code G0279 (diagnostic digital breast tomosynthesis) should be listed separately in addition to the primary service mammogram code 77066 or 77065. CPT codes 77061, 77062, and 77063 cannot be reported with the 3D rendering codes 76376 and 76377.
Must the use of CAD be dictated in the report? No, an order is not required for the use of CAD performed in conjunction with breast imaging procedures, such as mammography, MRI, and ultrasound.
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.
NOTE: Mammograms will not interfere with your ICD or S-ICD. However, your device could be damaged if it gets compressed in the mammogram machine. Make sure the doctor or technician knows you have an implanted device.
Bilateral mammography Bilateral mammograms represent the standard or traditional type of mammography. In these, the mammogram machine x-rays the breast tissue from a top and side view. Since a bilateral screening mammogram only shows the breast tissue from two angles, there's little compensation for overlap.
DIAGNOSIS CODES The proper diagnosis code to report would be Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast. The Medicare deductible and co-pay/coinsurance are waived for this service.
Screening mammography is recommended for women age 40 and older every one to two years and younger than 40 years of age when the patient has increa...
Insurance companies follow the above recommendations as well and set guidelines that allow payment at 100% of allowable fee schedule for a screenin...
Proper reporting of ICD-9-CM codes informs the insurance company the service was for screening mammography. If incorrectly billed, the claim may be...
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be act...
Diagnostic Mammography: Diagnostic mammography includes additional x-ray views of each breast, taken from different angles and if performed digitally, may be manipulated, enlarged, or enhanced for better visualization of the abnormality found during screening mammography.
Screening Mammography: Screenings are performed on otherwise healthy individuals to look for cancer or precursors to cancer of the breasts.
In general, screening mammograms are not recommended for women under 40 years of age, in part because breast tissue tends to be more dense in younger women, making mammograms as a screening tool less effective.
CAD: Computer-Aided Detection (CAD) is a computer-based process that is used in conjunction with digital mammography to analyze mammographic images and identify suspicious areas by marking them and bringing them to the radiologist's attention.
There is a technique that technicians should be trained in that allows them to better visualize breast tissue surrounding the implants called 'implant displacement views .'. Patients with implants after mastectomy should have orders that clarify if the physician wants the reconstructed breast to be screened as well.
Report code V76.12 (Screening for malignant neoplasms, other screening mammogram) for all other screening mammography. If the patient has a personal history of breast cancer, has completed active treatment and is back to annual mammographic screening, report V76.11.
Digital mammography is when images are taken and saved to a computer, which can then be enhanced, magnified, and manipulated as needed to aid in a more accurate diagnosis of early stage breast cancers or patients with very dense breast tissue.
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L33950 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography.
It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
An abnormal screening mammogram requires a diagnostic test to confirm whether cancer is present. Lesions that are suggestive of cancer are evaluated with tissue biopsy. If a noninvasive diagnostic test is available that can accurately exclude cancer; many women with an abnormal mammogram could avoid biopsy.
A diagnostic mammography is a radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, or a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease, and includes a physician’s interpretation of the results of the procedure.
Medicare Part B covers diagnostic mammography services if they are furnished by a facility that meets the certification requirements of section 354 of the Public Health Service Act (PHS Act), as implemented by 21 CFR part 900, subpart B.
Asymptomatic women ages 40 and older are eligible for a screening mammography (digital and non-digital) performed after at least 11 months have passed following the month in which the last screening mammography was performed. Women between the ages of 35 and 39 are eligible to receive one baseline screening mammogram.
A screening mammography is a radiologic procedure furnished to a woman without signs or symptoms of breast disease, for the purpose of early detection breast cancer,and includes a physician’s interpretation of the results of the procedure .
Diagnostic mammogram (s) are allowed for the following indications: -the patient is under the care of the referring/ordering physician or qualified non-physician practitioner; -there are signs and/or symptoms suggestive of malignancy (mass, some types of spontaneous nipple discharge or skin changes);
Currently under the CM S FAQ issued in November 2013, tomosynthesis is not separately billable.
As shown in Table C, codes 77046 and 77047 are reported for breast MRI without contrast.
Contrast-enhanced digital mammography (CEDM) may be also be ordered. A CEDM is a mammogram that uses iodinated contrast dye. This dye makes it easier to find new blood vessels that develop when cancers grow. CEDMs find breast cancers that can’t be seen on regular mammograms, especially in women with dense breasts.
Screening mammography is performed for a person without signs or symptoms of breast disease. Diagnostic mammography is performed for a person with signs or symptoms of breast disease, a personal history of breast cancer, or a personal history of biopsy.
Modifiers that can be used with CPT® codes 76641 or 76642 include: 1 50 – Bilateral procedure. This modifier is used to bill bilateral procedures that are performed at the same operative session. Under the Medicare physician fee schedule (MPFS), payments are adjusted to 150 percent of the unilateral payment when a service has a bilateral payment indicator assigned. 2 26 – Professional component. A physician who performs the interpretation of an ultrasound exam in the hospital outpatient setting may submit a charge for the professional component of the ultrasound service by appending this modifier to the ultrasound code. 3 TC – Technical component. This modifier is used to bill for services by the owner of the equipment to report the technical component of the service. This modifier is commonly used when the service is performed in an independent diagnostic testing facility (IDTF).
When mammography reveals an abnormal finding, a breast ultrasound may be used during a needle biopsy or as a follow-up test. A breast ultrasound alone is not considered a good breast cancer screening tool.