Radiology Coding Alert

Keep your HCPCS book close to stay out of trouble

New technology is making it more cost-effective than ever before to switch from analog to digital mammography, which means you need to get used to using new codes, too.

You can code digital mammograms like a pro the first time. Here's how.

Differentiate Between CAD and Direct Digital

Radiologists use CAD (computer-aided detection) to scan analog mammograms, usually converting them to digital data, to analyze the images for suspicious areas.
Direct digital mammography replaces the x-ray film with sensors that convert x-rays into electrical signals that produce an image on a computer screen or print on special film.

Add These Codes for CAD

The CPT manual has two add-on codes for mammograms, says Kim Garner Huey, CPC, CCS-P, CHCC, Alabama coding consultant and professional medical coding curriculum instructor in her audioconference for The Coding Institute, "Coding, Documentation, and Reimbursement Guidance for Breast Procedures":

• +76082--Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography

• +76083--... screening mammography.

Remember: Add-on codes "describe additional intra-service work associated with the primary procedure," performed by the same physician, according to CPT guidelines.

Put it in practice: Code 76082 includes a note to report the code in conjunction with analog diagnostic mammography codes 76090 (Mammography; unilateral) or 76091 (...bilateral). So, for a unilateral analog diagnostic mammogram with CAD, you should report 76090 and 76082. For a bilateral analog diagnostic mammogram with CAD, report 76091 and 76082.

Don't forget: NCCI 12.3 goes into effect Oct. 1. We'll cover the changes you need to know in next month's issue.

Code 76083 includes a note to use it in conjunction with 76092 (Screening mammography, bilateral [two-view film study of each breast]). So for a bilateral analog screening mammogram with CAD, you should report 76092 and 76083.

Watch for: The radiology report must document that "Computer-aided diagnosis was utilized for this exam," says Barbara Rutigliano, MS, RT(R), CPC, RCC, coding manager for Jefferson Radiology in East Hartford, Conn.

Look to G Codes for Direct Digital
 
When coding for mammography using direct digital imaging, as opposed to analog imaging, you should use the following codes, Rutigliano says:

• Screening Mammography: G0202--Screening mammography, producing direct digital image, bilateral, all views

• Diagnostic Mammography, Bilateral: G0204--Diagnostic mammography, producing direct digital image, bilateral, all views

• Diagnostic Mammography, Unilateral: G0206--Diagnostic mammography, producing direct digital image, unilateral, all views.

Important: The radiology report must document that "direct digital imaging was utilized for this exam," Rutigliano says.

Tip: You can use add-on codes 76082 and 76083 with digital mammography, as well as analog mammography, she says.

Rutigliano offers up examples of typical reports for these services:
 
Typical report for digital screening mammogram with CAD:

• Direct digital imaging was utilized for this exam

• Computer-aided diagnosis was utilized for this exam

• Comparison is made to film dated ____________

• Right breast findings: ___________

• Left breast findings: ____________

• Impression: __________

Your claim for this report should include G0202 and 76083, Rutigliano says.
 
Typical report for digital bilateral diagnostic mammogram with CAD:

• Direct digital imaging was utilized for this exam

• Computer-aided diagnosis was utilized for this exam

• Comparison is made to film dated ____________

• Right breast findings: ___________

• Left breast findings: ____________

• Impression: __________
  
Your claim for this report should include G0204 and 76082, Rutigliano says.

Typical report for digital unilateral diagnostic mammogram without CAD:

• Direct digital imaging was utilized for this exam

• Computer-aided dx was not utilized for this exam

• Right breast findings: _________

• Impression: __________

Your claim for this report should include G0206, Rutigliano says.

Caution: Don't use CAD add-on codes for normal reader review of a digital mammogram on the radiologist's work station, even if he used image manipulation during his analysis. The CAD add-on codes describe independent analysis with computer assistance in addition to the radiologist's independent read at the digital console.

Helpful: Just as with analog mammography, you may report screening and diagnostic mammograms for the same patient on the same day. How: Report screening code G0202, and append modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to the diagnostic code (G0204, bilateral; or G0206, unilateral).

Remember: Medicare requires HCPCS Level II codes when you report digital mammograms, but non-Medicare insurers may not accept these codes. Consult with private payers before submitting claims for these services using HCPCS codes.