Mammogram is done to check any abnormal finding present in the breast area. In US, due to breast cancer, female residents are periodically goes for a screening exam. This exam is just a routine checkup to be aware of any preventive measure for breast cancer. This screening exam is called as screening mammogram.
CPT code for digital screening mammogram is frequently used in medical coding. Since, the exam is done periodically hence we get a lot of reports of screening mammogram. Their are bundled CPT codes for diagnostic and screening mammogram from 2017. So let us checkout the CPT codes in mammogram in Radiology facility.
Bilateral screening mammography is performed with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The X-rays used in mammography have a longer wavelength than those typically used for bone imaging. A screening mammogram is performed on asymptomatic women for early breast cancer detection when there are no known palpable masses. This is performed on both breasts with two views taken on each side.
The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better-quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the X-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.
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Revised CPT codes for Mammogram
Bundled codes were introduced in 2017 for diagnostic and Screening Mammogram. These new CPT codes are bundled with computer-aided-detection (CAD) and mammography. The old CAD and mammography codes 77051, 77052, 77055, 77056, and 77057 will be deleted in 2017. But, in 2018 the HCPCS Level II G codes G0202, G0204 and G0206 will be discontinued to be used in 2018 for Medicare patients. Below are the new CPT codes in 2018 for diagnostic and Screening Mammogram all payers.
CPT code 77063 is an add-on code describing screening digital tomosynthesis for mammography. This procedure requires performance of a screening mammography producing direct digital images. Beginning calendar year 2018 CPT code 77063 may be reported with CPT code 77067. (HCPCS code G0202 was deleted January 1, 2018.)
77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
For claims with dates of service January 1, 2017, through December 31, 2017, report HCPCS codes G0202, G0204, and G0206. For claims with dates of service on or after January 1, 2018, report CPT codes 77067, 77066, and 77065 respectively.
Screening and diagnostic mammography are normally not performed on the same date of service. However when the two procedures are performed on the same date of service, Medicare requires that the diagnostic mammography HCPCS/CPT code be reported with modifier GG (performance and payment of a screening and diagnostic mammogram on the same patient, same day) and the screening mammography HCPCS/CPT code be reported with modifier 59.
Deleted HCPCS codes for Mammogram in 2018
G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
G0204 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
G0206 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
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CPT codes used for Digital breast tomosynthesis technology (DBT)
Digital breast tomosynthesis technology (DBT) is rapidly being implemented as it provides a higher diagnostic accuracy compared to conventional mammography. It is also referred to as three-dimensional (3D) mammography, which creates a three-dimensional picture of the breast from many angles using low-dose x-rays.
The breast is positioned in a similar fashion to a conventional mammogram, with slightly less compression, while a scanner rotates around the breast in an arc formation. Several images, usually between 10 and 15, are taken over approximately seven seconds.
While more images are taken, DBT does not require any more radiation than conventional mammography. 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, better morphological analysis of masses and architectural distortions, and a reduction in callbacks for additional testing.
Report 77061 when DBT is performed on one breast and 77062 when DBT is performed on both breasts. Report CPT code 77063 for bilateral screening DBT performed in addition to a primary procedure.
Additional Code Information CPT code 77065
Additional Code Information CPT code 77066 & 77067
Deleted CPT codes for digital Screening Mammogram & Diagnostic Mammogram
The patient, which has any abnormal finding in breast like breast mass or lump, calcification, micro calcification, cyst in breast etc. are generally goes for Diagnostic mammogram. If the physician is suspicious about the abnormal finding then they can go for breast biopsy also. The biopsy procedure will help to know the exact nature of the abnormal finding present in breast.
Hence, the difference between the both diagnostic and screening mammogram is very simple, during screening exam present do not have any abnormal or suspicious finding in breast, on the contrary diagnostic exam is done when there are any abnormal or suspicious finding are present in breast. Now, let checkout the CPT code for digital screening mammogram and diagnostic mammogram.
Procedure Description Digital Exam CPT code Bilateral Digital Exam CPT code Unilateral Non-digital exam CPT code Bilateral Non-digital exam CPT code Unilateral Screening Mammogram 77067 77067-52 77067 77067-52 Diagnostic Mammogram 77066 77065 77066 77065
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ICD 9 & 10 codes used with CPT code for digital screening mammogram
There are only two icd codes used with Screening mammogram, V76.12 and V76.11. These two V codes are used for High-risk patient (V76.11) and Normal patient (V76.12). The high-risk patients are those, which have any past history or family history of breast cancer. Normal Patients do not have any history or family history of breast cancer. These two V codes should be used with CPT code for digital screening mammogram. The common icd codes used with diagnostic mammogram are breast mass or lump (611.72), abnormal mammogram (793.80), breast calcification (793.89) and breast micro calcification (793.81).
V76.12 – Z12.31 Encounter for screening mammogram for malignant neoplasm of breast
V76.11- Z12.31 Encounter for screening mammogram for malignant neoplasm of breast
611.72 – N63 Unspecified lump in breast
793.80 – R92.8 – Other abnormal and inconclusive findings on diagnostic imaging of breast
793.81 – R92.0 – Mammographic microcalcification found on diagnostic imaging of breast
793.89 – R92.8 – Other abnormal and inconclusive findings on diagnostic imaging of breast
CAD code bundled with CPT code for Digital Screening Mammogram
The CAD is referred as Computer Aided Detection. It is generally used with digital diagnostic and screening mammogram. The CAD is mostly used with mammogram. The CAD code is now bundled with diagnostic mammogram and with screening mammogram procedure codes from 2017.
Physician Quality Reporting System (PQRS) used along with Screening Mammogram
Measure 146
| CPT Codes | |||
| Code | Modifier | POS | Description |
| 77067 | Screening mammography, bilateral (2-view study of each breast) | ||
| 3340F | Mammogram assessment category of “incomplete: need additional imaging evaluation” documented (RAD) | ||
| 3340F | Mammogram assessment category of “incomplete: need additional imaging evaluation” documented (RAD) | ||
| 3341F | Mammogram assessment category of “negative,” documented (RAD) | ||
| 3341F | Mammogram assessment category of “negative,” documented (RAD) | ||
| 3342F | Mammogram assessment category of “benign,” documented (RAD) | ||
| 3342F | Mammogram assessment category of “benign,” documented (RAD) | ||
| 3343F | Mammogram assessment category of “probably benign,” documented (RAD) | ||
| 3343F | Mammogram assessment category of “probably benign,” documented (RAD) | ||
| 3344F | Mammogram assessment category of “suspicious,” documented (RAD) | ||
| 3344F | Mammogram assessment category of “suspicious,” documented (RAD) | ||
| 3345F | Mammogram assessment category of “highly suggestive of malignancy,” documented (RAD) | ||
| 3345F | Mammogram assessment category of “highly suggestive of malignancy,” documented (RAD) | ||
| 3350F | Mammogram assessment category of “known biopsy proven malignancy,” documented (RAD) | ||
| 3350F | Mammogram assessment category of “known biopsy proven malignancy,” documented (RAD) | ||
| HCPCS Codes | |||
| Code | Modifier | POS | Description |
| 77067 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed | ||
PQRS Measure 225
| Code | Modifier | POS | Description |
| 77067 | Screening mammography, bilateral (2-view study of each breast) | ||
| 7025F | 8P | Patient information entered into a reminder system with a target due date for the next mammogram (RAD) | |
| 7025F | Patient information entered into a reminder system with a target due date for the next mammogram (RAD) | ||
| 7025F | 1P | Patient information entered into a reminder system with a target due date for the next mammogram (RAD) | |
| 7025F | Patient information entered into a reminder system with a target due date for the next mammogram (RAD) | ||
| 7025F | 8P | Patient information entered into a reminder system with a target due date for the next mammogram (RAD) |