Oncology & Hematology Coding Alert

Question: What is the difference between molecular breast imaging (MBI) and scintimammography, and how do I code for them?

South Carolina Subscriber

Answer: MBI and scintimammography are synonyms for the same procedure, which is used for breast cancer cell detection in women whose mammograms are abnormal, or who have conditions such as scar tissue or dense breast tissue that make regular mammograms or ultrasound unreliable for detecting breast abnormalities.

The procedure involves injecting a radioactive tracer, most commonly technetium-99m sestamibi, into the breasts. Any cancer cells present will accumulate the substance in greater amounts than normal breast cells, making them easier to detect with a gamma camera and allowing for easier biopsy of the cells.

For this procedure, you would use 78800 (Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); limited planar, single area (eg, head, neck, chest, pelvis), single day imaging).

Red flag: Use 78800 whether your provider performed the procedure unilaterally or bilaterally and not 78801 (… multipleplanar, 2 or more areas ...) if performed bilaterally. That’s because “both breasts are considered a single limited area” per CPT^® Assistant (December 2011). For the same reason, you would not append either LT (Left side (used to identify procedures performed on the left side of the body)) or RT (Right side (used to identify procedures performed on the right side of the body)).

In addition to reporting the procedure, you should also report the radiopharmaceutical with the appropriate HCPCS code, such as A9500 (Technetium Tc-99m sestamibi, diagnostic, per study dose).

Note: Payers who accept S codes may instruct you to report S8080 (Scintimammography [radioimmunoscintigraphy of the breast], unilateral, including supply of radiopharmaceutical). Notice how the code descriptor specifies it represents a unilateral service, so you will need to append either LT or RT laterality modifiers as appropriate. The descriptor also stipulates that the service includes the tracer, so you would not add a HCPCS code such as A9500 to your documentation.