CPT® Guidelines: Avoid These Pitfalls on 2019 Breast MRI, CAD Combo Coding

Why This Topic Matters

Breast MRI coding changed significantly in 2019, and uncertainty around CAD-related reporting can affect claim accuracy, payer consistency, and facility reimbursement. The article helps readers understand the scope of the issue and where official clarification is still needed.

Article Sections

1. See How the Problem Begins and Ends with +0159T

   This section introduces the breast MRI code changes and the related CAD add-on code issue. It outlines the transition from older breast MRI reporting to the updated code structure.

2. Addressing This Semantic Error, and What to Do Next

   This section discusses an apparent inconsistency in published CPT commentary and explains why the matter is being treated as unresolved pending clarification. It also references related CPT parenthetical guidance.

3. Use 76376, 76377 Parentheticals as a Reference

   This section looks at related imaging parentheticals and comments from coding professionals about how the breast MRI changes may be interpreted. It also mentions the Medicare Physician Fee Schedule.

4. Report This New HCPCS Code in the Meantime

   This section covers outpatient facility reporting considerations and the HCPCS codes discussed for breast MRI services in the OPPS setting. It also notes CMS-related billing limitations and the possibility of later payer follow-up.