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:
Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis code assigned for a screening mammogram.
Group 1CodeDescription77065DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL77066DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL16 more rows
Per the CPT® 2021 codebook, Professional Edition, p. 536, code 76641 represents a complete ultrasound examination of the 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.
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).
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.
This is called a diagnostic mammogram. The basic procedure for a diagnostic mammogram is the same as for a screening mammogram, but the diagnostic mammogram includes more images of the breast. Breast ultrasound uses sound waves to make images of the breast. Like a diagnostic mammogram, it's considered non-invasive.
CodeDescription76641Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete76642… limited
CPT code 76641 for breast ultrasound represents a complete examination of all four quadrants of the breast and the retroareolar region. On the other side, the limited code, 76642, is for a focused exam of the breast that is limited to one or more of the elements included in 76641.
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).
Z12. 11: Encounter for screening for malignant neoplasm of the colon.
Z12.11. Encounter for screening for malignant neoplasm of colon.