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Internal Medicine Coding Alert

Please Payers With Covered Mammogram Diagnosis Codes

Published on Thu May 01, 2003

Don't differentiate a screening mammography from a diagnostic mammography and then blow it by linking the procedure code to a noncovered diagnosis code.

When ordering a bilateral screening mammogram, 76092 (Screening mammography, bilateral [two view film study of each breast]) or G0202 (Screening mammography, producing direct digital image, bilateral, all views), for a low-risk patient, link the procedure code to V76.12 (Other screening mammogram).

For a high-risk patient, link the appropriate screening mammography procedure code to V76.11 (Screening  mammogram for high-risk patient). You should also account for any additional pertinent information when applicable with additional ICD-9 V codes, i.e., V10.3 (Personal history of malignant neoplasm; breast), V15.89 (Other specified personal history presenting hazards to health; other) or V16.3 (Family history of malignant neoplasm; breast).

Choosing ICD-9 codes for diagnostic mammograms is not as easy because covered diagnosis codes vary from carrier to carrier. Reliable ICD-9 codes for 76090 (Mammography, unilateral), 76091 ( bilateral), G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views) and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views) include but are not limited to:

  • 174.0-174.9 Malignant neoplasm of female breast
  • 198.81 Secondary malignant neoplasm of other specified sites; breast
  • 238.3 Neoplasm of uncertain behavior of other and unspecified sites and tissues; breast
  • 239.3 Neoplasms of unspecified nature; breast
  • 451.89 Phlebitis and thrombophlebitis of other sites, other
  • 610.0-611.79 Disorders of breast
  • 611.8 Other unspecified disorders of breast
  • 675.10-675.14 Infections of the breast and nipple associated with childbirth; abscess of breast
  • 675.20-675.24 nonpurulent mastitis
  • 793.80 Abnormal mammogram, unspecified
  • 793.81 Mammographic microcalcification
  • 793.89 Other abnormal findings on radiological examination of breast
  • V10.3 Personal history of malignant neoplasm; breast

     

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