Radiology Coding Alert

Breast Imaging:

Crack These 5 Breast Imaging Myths Using Updated ACR Guidance

Published on Wed Apr 21, 2021

Ensure coding compliance beyond just mammograms.

Staying up to date on guidance surrounding high frequency breast imaging services is crucial to ensure coding processes are streamlined and efficient. Part of this process involves your being able to distinguish between varying forms of coding fact and fiction.

On that front, the American College of Radiology (ACR) recently published updated coding guidance on a variety of breast imaging services that will help to dispel a few circulating myths.

Read on to tackle some common myths surrounding mammograms, breast ultrasounds (USs), biopsies, and more.

Consider Diagnostic Mammogram Ordering Requirements

Myth #1: Diagnostic radiologists cannot order diagnostic mammograms following detection of screening mammogram abnormalities.

Reality: First and foremost, you may code for screening and diagnostic mammograms on the same day of service. “Furthermore, the interpreting provider can order a diagnostic mammogram to be performed on the same day, or a following day, when an abnormality is detected on the screening mammogram,” instructs Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. When a diagnostic mammogram is performed on the same day as a screening mammogram, make sure to append modifiers GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) and 59 (Distinct procedural service) to the diagnostic mammogram code.

Include Same-Day Mammogram Services on Same, Separate Reports

Myth #2: Screening and diagnostic mammograms performed on the same-day require individual reports.

Reality: For Medicare patients, you have the option to report same-day screening and diagnostic mammograms as separate or combined reports. Check with third party payer guidelines on whether they allow for combined reporting. However, if your provider combines mammograms into one dictation report, they need to abide by a set of specific ACR criteria for proper reporting. These criteria include:

A single overall final assessment;
Documentation supporting that the report includes the combined results of the screening and diagnostic mammograms.

Know What’s Included in Diagnostic Tests Rule Exception

Myth #3: A written order is required for breast tomosynthesis studies performed with diagnostic mammograms.

Reality: While breast tomosynthesis studies must be documented within the dictation report of the diagnostic mammogram, a specific order for the tomosynthesis is not required. As the ACR explains, a tomosynthesis order falls within the Order of Diagnostic Tests Rule Exception, which you can learn more about in Chapter 15 of the Medicare Benefit Policy Manual.

On the same token, you won’t find any requirement for an order for the use of computer-aided detection (CAD) with any breast imaging services. For code descriptions that include CAD, such as breast magnetic resonance imaging (MRI) scans, the provider also does not need to include a statement referencing the use of CAD in the report. However, for an imaging service that does not include CAD use in the code description, such as a US, the provider should indicate in the dictation report that CAD software was utilized.

Don’t Bank On Breast US Screening Services Getting Reimbursed

Myth #4: Medicare will reimburse for breast ultrasound (US) screening studies.

Reality: While Medicare will reimburse for a limited or complete breast US “when clinically indicated,” the same cannot be said for breast US screening services. In fact, only when mandated by Congress will Medicare reimburse for a breast US screening study.

For breast US studies that are performed for screening purposes, you should inform the patient prior to the service that they will be responsible for payment. You should require that the patient sign an Advanced Beneficiary Notice (ABN) prior to undergoing the procedure.

Group Calcifications Into Single Lesion for Breast Biopsies

Myth #5: You should report a breast biopsy add-on code for each additional breast calcification documented beyond the first.

Reality: You should not consider breast calcifications as interchangeable with breast lesions. In fact, the ACR indicates that a grouping of calcifications should be considered a single lesion. Only in the instance that there are two distinct groupings of calcifications should you consider reporting an add-on code to indicate that the provider biopsied more than one mass, or lesion.