While an ultrasound is very useful for evaluating superficial lumps, a mammogram is better at detecting abnormalities deeper within the breast tissue. Microcalcifications are tiny accumulation of calcium around a tumour and are often picked up on mammograms.
You might be told:
If the additional views are done on the same day as the screening mammogram, the diagnostic study should be reported with the GG modifier, which Medicare uses for tracking purposes. This modifier designates the performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day.
ICD-10 Code for Person consulting for explanation of examination or test findings- Z71. 2- Codify by AAPC.
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.
For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient. However, coders are coming across many routine mammogram orders that use Z12. 39 (Encounter for other screening for malignant neoplasm of breast).
Other specified counselingICD-10 code Z71. 89 for Other specified counseling is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Persons encountering health services in other specified circumstancesZ76. 89 is a valid ICD-10-CM diagnosis code meaning 'Persons encountering health services in other specified circumstances'.
Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis code assigned for a screening mammogram. If the mammogram is diagnostic, the ICD-10-CM code assigned is the reason the diagnostic mammogram was performed.
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
Group 1CodeDescription77065DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL77066DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL16 more rows
ICD-10 code Z12. 39 for Encounter for other screening 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 .
ICD-10 Code for Other abnormal and inconclusive findings on diagnostic imaging of breast- R92. 8- Codify by AAPC. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. Abnormal findings on diagnostic imaging and in function studies, without diagnosis.
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.
Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00 -Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
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. Type 1 Excludes. encounter for diagnostic examination-code to sign or symptom. Use Additional.
In lieu of 77057, Medicare requires the use of code G0202 to report screening mammograms. If only one breast is screened, append modifier 52. Patients who have a history of breast disease, whether malignant or biopsy proven benign, fall into either the screening or diagnostic category.
Patients who report breast pain, lumps, nipple discharge, or other symptoms require diagnostic testing. Patients who have a personal history of breast cancer or biopsy confirmed non-malignant breast disease may also fall into the category of diagnostic.
The screening code is used when the patient is coming in for an annual mammogram. and has no breast issues. The diagnostic codes are used when the mammogram is being done for a specific promblem (ex: breast mass, breast pain, etc….). I hope this helps. Jasminka.
Patients who are asymptomatic and request a mammogram are categorized as screening. For Medicare, and many other payers, these patients do not require a physician order and may self refer to a mammography center.
Since the codes don ’t specify the number of views, use one code along with one billing unit to report your services regardless of the number of views taken. Men are also susceptible to breast diseases–including cancer. Male patients who exhibit symptoms and present for mammography are considered diagnostic.
Though many insurance companies, as well as CMS, cover screening mammography, there are still a wide variety of coverage issues. Payment for screening services is usually driven by the payer and the patient’s individual schedule of benefits.
Under these circumstances, Medicare directs us to bill both the screening mammogram and the appropriate diagnostic mammogram. To indicate that a screening mammogram has taken place and ended in the decision for a diagnostic service, attach modifier “GG” to the appropriate diagnostic code.