Coding Screening Mammograms

By Aimee Wilcox, MA, CST, CCS-P

What is mammography?

Mammography is a method of taking x-ray images of the breasts to identify tumors or abnormalities in the tissues that may indicate breast cancer.

Screening Mammography: Screenings are performed on otherwise healthy individuals to look for cancer or precursors to cancer of the breasts. Early detection of breast cancer through screening may allow for better forms of treatment and possible prevention of metastasis and mortality.

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.

Types of Mammography:

Analog or conventional mammography is when the radiologist takes an image and prints it on film for the radiologist to review on a light box.

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.

CAD: Computer-Aided Detection (CAD) is a computer-based process that is used in conjunction with digital mammography to analyze mammographic images and identify suspicious areas by marking them and bringing them to the radiologist's attention.

While the ACR (American College of Radiology) feels that CAD, when used with screening and diagnostic mammography, is a *valuable tool that aids in the detection of early breast cancer, there are other professional organizations that, after studying the results of mammograms performed with CAD, believe that it may instead make readings less accurate*.

When is mammography recommended?

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 increased risk factors for breast cancer.

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. As there is such a low risk of developing breast cancer in younger women, experts do not believe that it is justifiable to expose them to low levels of radiation or the cost of mammograms unless they do have *high risk factors.

CPT/HCPCS Coding for Screening Mammograms:

Insurance companies follow the above recommendations as well and set guidelines that allow payment at 100% of allowable fee schedule for a screening mammogram in women 40 years and older, every 1-2 years and in women younger than 40 years of age when their medical history indicates they are *high risk. If coded correctly, payment should be at 100% of the allowable fee schedule for preventive services.

CPT Coding for Screening Mammography:

Screening mammography is considered bilateral so do not report the code with modifier 50 or RT/LT.

ICD-9-CM Codes for Screening Mammography:

Proper reporting of ICD-9-CM codes informs the insurance company the service was for screening mammography. If incorrectly billed, the claim may be processed and paid at a lesser value.

There are two ICD-9-CM diagnosis codes used to report a screening mammogram:

Report code V76.11 (Screening for malignant neoplasms, screening mammogram for high risk patient) when any one of the following criteria is documented in the report:

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. No additional personal history code is required as V76.11 inherently covers this diagnosis; however, you may report a personal history of breast cancer (V10.3) as a secondary code if you like.

How do breast implants affect screening mammography?

Patient's with breast implants should still undergo screening mammograms; however, the implants can make it more difficult to see the breast tissue clearly. 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.

ICD-9-CM and CPT/HCPCS coding is reported in the same manner as other screening mammograms.

How do you code a screening mammogram for a patient with a mastectomy?

Patients with a mastectomy due to a fully treated breast cancer, no longer have breast cancer in that breast (as it has now been surgically removed). Once 'active treatment' is completed, the patient may return to annual screening mammograms. 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.

Screening Mammograms Performed Earlier Than Recommended:

Screening mammograms can be performed every year, as long as it has been a full 11 months or one year since the last screening mammogram. It is recommended that providers obtain a signed ABN (advanced beneficiary notification) from the patient prior to the procedure, as the insurance most likely will not cover the service and the patient will be left responsible for the cost. Lack of a signed ABN on file will result in the provider being forced to write off the service and be unable to bill the patient for it.

The following are some examples of how to code screening mammograms:

Example 1:

The patient is a 76-year old female presenting for annual screening mammogram today, (December 30, 2009). Her last mammogram was one year ago (December 15, 2008). She has a sister with breast cancer at age 56. Digital screening mammogram with CAD was performed. Findings: Negative.

CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.11

Example 2:

Patient is a 52-year old female with a personal history of breast cancer, fully resolved status post right breast mastectomy in 1992. She presents for annual digital screening mammogram with CAD.

CPT/HCPCS Codes: G0202-52, 77052
ICD-9-CM Codes: V76.11, V10.3

Example 3:

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. Implants appear stable and mammographically intact.

CPT/HCPCS Codes: G0202, 77052
ICD-9-CM Codes: V76.12

Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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