1 Breast - see also condition dense R92.2 2 Dense breasts R92.2 3 Findings, abnormal, inconclusive, without diagnosis - see also Abnormal mammogram NEC R92.8 ICD-10-CM Diagnosis Code R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast 2016 2017 2018 2019 ... 4 Inconclusive mammogram R92.2 (due to dense breasts)
CPT Coding for Screening Mammography: Analog (conventional) Mammography: Bilateral Screening Mammogram 77057 Digital Mammography: Bilateral Screening Mammogram G0202 Digital mammogram with CAD: Computer Aided Detection (CAD) 77052 (used with 77057 and G0202)
ACCEPTED Medicare Codes for Diagnostic Mammograms: Procedure: ICD 10 Codes: Screening Mammogram Z12.31 History of Breast Cancer Z85.3 Abnormal Mammogram R92.8 Induration of Breast N64.51 Nipple Discharge N64.52 Retraction of Nipple N64.53
History: A 42-year-old female, annual exam. Comparison: Mammogram one year prior. Findings: Bilateral digital implant screening mammogram, standard and displaced views were obtained. CAD utilized. Bilateral subglandular breast implants are noted.
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.
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.
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).
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.
ICD-9 Code V76. 12 -Other screening mammogram- Codify by AAPC.
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
Z12.11. Encounter for screening for malignant neoplasm of colon.
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.
Women with a personal history of cancer can have their routine annual 3D mammogram performed as a diagnostic or a screening examination. Most CEM is done as part of research studies at this time. In centers offering clinical CEM, billing is often under CPT code 77065 (one breast) or 77066 (both breasts).
For Screening Digital Breast Tomosynsthesis, effective for claims with dates of service January 1, 2018 and later, HCPCS code 77063, “Screening Digital Breast Tomosynthesis, bilateral, must be billed in conjunction with the primary service mammogram code 77067.
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...
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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.
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.
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.
Screening Mammography: Screenings are performed on otherwise healthy individuals to look for cancer or precursors to cancer of the breasts.
As a screening mammogram is inherently bilateral in nature, report modifier -52 when screening mammogram is performed on a patient with a history of mastectomy where only one breast is imaged.
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.
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.
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.