AMA Clinical Examples in Radiology - 2005 Issue 4 (Fall)
Diagnostic Mammography
Diagnostic Mammography Mammography is commonly performed for both screening and diagnostic purposes. The following is an example of a diagnostic mammogram performed on a patient who presents with a history of breast disease. Clinical History Family history of breast cancer. The patient is on hormone replacement therapy and reports new breast thickening and bilateral breast tenderness. Comparison is made to previous examinations of 12/23/02, 8/20/04. Findings Craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts and a CC magnification/compression spot film of the right breast were obained. There is moderate parenchymal radiodensity with increased patchy density in the...
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Article Overview
This article explains the scope of diagnostic mammography versus screening mammography and summarizes related coding and documentation considerations for breast imaging. It also references professional guidance and payment policy issues from ACR, CMS, and MQSA-related materials, making it useful for coders, radiology staff, and compliance teams working with mammography claims and reports.
Why This Topic Matters
Accurate mammography coding depends on distinguishing diagnostic from screening services, understanding when additional imaging is part of the study, and recognizing policy differences across organizations and payers. The article helps readers orient themselves to the relevant guidance without substituting for the full premium content.
Article Sections
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Clinical Example
An example mammography case is presented with imaging findings, impression, BI-RADS assessment, and follow-up recommendation. The section supports understanding of how diagnostic studies are documented in context.
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How to Code
This section identifies the primary coding focus for the example and frames the procedure type addressed in the article. It serves as the bridge between the clinical example and the later coding discussion.
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Discussion
General guidance is provided on distinguishing diagnostic from screening mammography and on the types of imaging views that may be involved. The section also introduces documentation considerations relevant to report content.
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Coding Tips
This section covers coding-related considerations tied to computer-aided detection, procedure ordering, and related reporting issues. It also notes when an unlisted procedure approach is not appropriate for certain mammography services.
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ACR Practice Guidelines
Professional guidance from the ACR is summarized, including supervision and mammography practice standards. The section also mentions related regulatory context and where additional guidance may be found.
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CMS Payment Policy
This section discusses CMS-related payment policy considerations affecting mammography scenarios, including circumstances involving implants, prior breast cancer treatment, and unilateral studies. It highlights the role of payer policy variation and patient notification.
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Resources
The article closes with source references and related publication details. These materials point readers to the underlying guidance documents cited in the discussion.
What You Will Learn
- How the article distinguishes diagnostic and screening mammography
- What kinds of documentation are emphasized for diagnostic breast imaging reports
- Which professional organizations and policy sources are referenced
- What broad coding and payment policy issues are discussed for mammography services
Who Should Read This
- Medical coders
- Radiology coders
- Compliance staff
- Radiology practice administrators
- Breast imaging staff
Codes Discussed
Modifiers Discussed
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