Oncology & Hematology Coding Alert

Question: Which codes apply to molecular breast imaging?

Codify Member

Answer: For the imaging, you should report 78800 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; limited area). The entity that bears the cost of the pharmaceutical should report it with the appropriate HCPCS code, such as A9500 (Technetium Tc-99m sestamibi, diagnostic, per study dose).

Why 78800? The American College of Radiology (ACR), Society of Nuclear Medicine (SNM) and CPT® Assistant (December 2011) all recommend using limited code 78800 whether you perform imaging on one or both breasts. “Just as imaging of the chest for other nuclear medicine procedures is considered one single limited area, both breasts are considered a single limited area as well,” states an ACR FAQ document (http://gm.acr.org/Hidden/Economics/FeaturedCategories/Pubs/coding_source/archives/JulyAugust2008/BreastImagingFrequentlyAskedQuestions.aspx).

Payer check: Do some research to see if your payer has a policy for this service. Many payers consider it investigational and will not cover it. Others may have specific medical necessity requirements. Alternatively, payers who accept S codes may instruct you to report S8080 (Scintimammography [radioimmunoscintigraphy of the breast], unilateral, including supply of radiopharmaceutical). Note that S8080 specifies it represents a unilateral service.

Imaging: Molecular breast imaging may be referred to as MBI, breast-specific gamma imaging (BSGI), or scintimammography (SMM). The provider administers radioactive tracers intravenously and then uses a gamma camera to detect the breast tissues that accumulate higher levels of the tracer. This can help in determining areas to biopsy.