Confirm Breast Cancer Screening Coding



Breast Cancer Awareness month is the perfect time to review your practice’s medical coding for preventive and diagnostic breast imaging.

Every October, we wear pink and participate in charity events to show our support for breast cancer awareness. It is also a great time to review your coding practices for mammography and other breast imaging to ensure you are following current guidelines.

Coding Mammography

The Centers for Medicare & Medicaid Services (CMS) recognizes CPT® mammography codes, shown in Table A. These codes replaced the HCPCS Level II G codes (G0202, G0204, and G0206) CMS used until Jan. 1, 2018.

Table A: Mammography codes

CPT®/HCPCS Level II CodeDescriptor
Screening Breast Tomosynthesis (Bilateral)
77067Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
+77063Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
Diagnostic Breast Tomosynthesis (Unilateral)
77065Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
+G0279Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to 77065 or 77066)
Diagnostic Breast Tomosynthesis (Bilateral)
77066Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
+G0279Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to 77065 or 77066)

Use the CPT® and HCPCS Level II codes in Table A when reporting mammography services. Be sure the services ordered and performed match the code descriptor and that you don’t confuse a screening mammogram with diagnostic mammography:

  • 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.

Coding Breast Ultrasonography

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.

Use the CPT® codes in Table B, as appropriate, when reporting ultrasound services.

Table B: Breast ultrasound codes

CPT® CodeDescriptor
76641Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
76642Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited
Elastography
76981Ultrasound, elastography; parenchyma (eg, organ)
76982Ultrasound, elastography; first target lesion
+76983Ultrasound, elastography; each additional target lesion (List separately in addition to code for primary procedure)

Modifiers that can be used with CPT® codes 76641 or 76642 include:

  • 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.
  • 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.
  • 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).

How to Report Alternative Testing

For those with a breast cancer diagnosis or for those at high risk of breast cancer, magnetic resonance imaging (MRI) may be ordered. An MRI can provide clearer 3D images of the breast, which are then used to either assess the extent of breast cancer or to screen for breast cancer in women thought to have a high risk of the disease. As shown in Table C, codes 77046 and 77047 are reported for breast MRI without contrast. MRI with computer-aided detection (CAD) can help radiologists identify abnormalities on breast MRI and is reported with codes 77048 and 77049, also shown in Table C.

Table C: MRI codes

CPT® CodeDescriptor
77046Magnetic resonance imaging, breast, without contrast material; unilateral
77047Magnetic resonance imaging, breast, without contrast material; bilateral
77048Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral
77049Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral

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. Less expensive than an MRI, CEDMs may also have lower false-positive rates than breast MRIs, resulting in increased diagnostic accuracy. The codes are shown in Table D.

Table D: Contrast-enhanced digital mammography codes

CPT®/HCPCS Level II CodeDescriptor
96374Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
76499Unlisted diagnostic radiographic procedure
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Now that you’ve updated your breast imaging coding skills, be sure to read “The Power of Pink!” to learn how you can help those around you to take charge of their breast health.


Resources:

MLN Matters MM10181, Aug. 18, 2017, CMS

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