Basic about  Breast Tomosynthesis cpt codes

Digital 3-D breast imaging (tomosynthesis) is able to diagnose smaller lumps and to lower false positives. Input from multiple radiology groups prompted creation of the diagnostic (77061 and 77062) and screening (77063) tomosynthesis codes in order to describe the additional resources involved with the newer technology. Breast procedures are always little complicated like breast biopsy, ultrasound exam. But, if once you understood the whole concept, it is easy to apply these codes.

Digital breast tomosynthesis (DBT), also know as three-dimensional (3D) mammography, creates a three-dimensional image of the breast from many angles using low dose x-rays. The breast is positioned in a similar fashion like in mammogram, while a scanner rotates around the breast in an arc formation. Several images, usually between 10 to 15, are taken over approximately 7 seconds. Once the images have been taken, computer programs produce clear and highly focused 3D representations of the breast that the radiologist can then view as thin layers of breast tissue, similar to CT scan images. This technology allows for greater accuracy, easier identification of abnormalities, and a reduction in callbacks for additional testing. Assign CPT code 77061 when DBT is performed on one breast and CPT code 77062 when DBT is performed on both breasts. Use code 77063 for bilateral screening DBT performed in addition to a primary procedure.

• 77061 Digital breast tomosynthesis; unilateral
• 77062 Digital breast tomosynthesis; bilateral

+77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)

G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to Diagnostic Mammography codes 77065 or 77066)

Do not report 77063 in conjunction with 76376 or 76377 (three-dimensional reconstruction), 77055 and 77056 (conventional diagnostic mammography)

Do not report 77061, 77062 in conjunction with 76376 or 76377 (three-dimensional reconstruction).

CMS created HCPCS code G0279 as an add-on code to the relevant 2-D diagnostic mammography codes G0204 (deleted) and G0206(deleted), when diagnostic mammography is furnished using 3-D mammography. CPT codes 77061 and 77062 are Status Indicator E, which is non-covered for Medicare.

Related CPT codes for breast tomosynthesis

Along with diagnostic and screening mammogram, we have separate procedure codes for breast ultrasound exams. In radiology, we have limited and complete ultrasound cpt codes for breast procedures. 

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete

76642 ; limited

Common diagnosis with breast Procedure codes

Being a radiology coder, I used to code almost 50 charts related to breast Procedures.

If we are coding screening mammogram exam of breast for malignancy, cpt code 77057, then we have to use only screening Z code, Z12.31 as primary diagnosis, followed by the other incidental diagnosis as secondary diagnosis.

For diagnostic mammogram  exam 77065 and 77066 , we have to assign breast related diagnosis as primary. Most common diagnosis for these exams will be from N63* series for breast mass or lump.

Now, we have more specific codes for breast mass or lump for each specific quadrant of breast.

There are diagnosis of breast calcification, R92.1 or microcalcification, R92.0, used frequently while coding diagnostic mammogram breast exam.

For ultrasound breast exams, cpt code 76641 and 76642, we usually get the breast cyst as final diagnosis. You have to use N60.01 or N60.02 for coding breast solitary OR Single cyst for right and left breast. 

For presence of multiple cyst in breast, we have to use separate ICD 10 code for fibrocystic breast.