Radiology Coding Alert

Master the codes before federal regulations change.

As a radiology coder, you’ll want to take special interest in 18 new codes in the 2024 ICD-10-CM code set. Effective Oct. 1, 2023, you’ll use codes in the R92.3- (Mammographic density found on imaging of breast) code subcategory to report breast tissue density findings from screening and diagnostic mammography exams.

Read on to learn how to correctly assign the R92.3- codes and how the conditions differ.

Get to Know the New R92.3- Codes

Starting October 1, you’ll assign codes from the following code subcategories depending on the provider’s documented findings:

• R92.31- (Mammographic fatty tissue density of breast)
• R92.32- (Mammographic fibroglandular density of breast)
• R92.33- (Mammographic heterogeneous density of breast)
• R92.34- (Mammographic extreme density of breast)

Each of the above codes require a 6th character to complete the code, and that final character is used to specify laterality. You’ll use “1” for the right breast, “2” for the left breast, or “3” for a bilateral diagnosis. For example, you’ll assign R92.313 (Mammographic fatty tissue density, bilateral breasts) when the provider issues a finding of fatty tissue density in both breasts.

“Fatty breast tissue density is found in about 10 percent of women, fibroglandular and heterogenous breast tissue densities are both found in about 40 percent of women, and extremely dense breast tissue is found in about 10 percent of women,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

The 2024 ICD-10-CM code set also includes R92.30 (Dense breasts, unspecified). You’ll assign this code if the provider’s documentation doesn’t indicate a specific type of breast tissue density. This code should be used rarely since the code set includes the four new code subcategories listed above, which allow you to assign diagnosis codes to match the documented breast tissue density.

Understand the Different Density Categories

“The differences between R92.31-, R92.32-, R92.33-, and R92.34- involve the amount of dense to nondense tissue in the breasts and relate to the results reporting system called Breast Imaging Reporting and Data System (BI-RADS). BI-RADS is commonly referenced in mammogram reports, and it classifies the breast density level into four categories from A to D,” says Taylor Berrena, COC, CPC, CPB, CRC, CPMA, CEMC, CFPC, CHONC, coder II at MD Anderson Cancer Center at Cooper in Yorktown, Virginia.

The BI-RADS breast density categories are as follows:

• Category A: Breasts consist almost entirely of fatty tissue with almost no dense tissue.
• Category B: Breasts consist of a few, scattered areas of fibroglandular density. Most of the breast tissue is still nondense or fatty.
• Category C: Breasts consist of a near equal ratio of dense to nondense tissue. Small masses may be hidden.
• Category D: Breasts consist almost entirely of dense tissue, and the density is so extreme it can lower the sensitivity of the mammogram.

You’ll assign R92.31- codes for Category A or when the provider documents the breast tissue as “nondense” or “fatty tissue.” Category B describes conditions represented by the R92.32- codes. Assign R92.33- codes for findings under Category C or listed as “heterogeneously dense breast tissue.” Lastly, you’ll assign codes from R92.34- for Category D or findings listed as “extremely dense breast tissue.”

Since mammograms are black-and-white images, dense tissue makes mammograms harder to interpret. While fatty tissue appears as dark areas on mammograms, dense breast tissue appears as white areas on the image. Abnormalities in the breast, such as cysts, calcifications, and neoplasms, also appear as white areas, and if abnormalities occur in the same areas where there is dense tissue, a radiologist could miss the abnormalities on initial scans.

Scenario: A patient presents for their annual screening mammography exam. After capturing images, the radiologist interprets the results, and compiles their report. The provider documents that the patient has heterogeneously dense tissue in both breasts. No masses, calcifications, or other abnormalities were seen.

You’ll assign R92.333 (Mammographic heterogeneous density, bilateral breasts) to report the findings of the patient’s screening mammogram, which falls under BI-RADS Category C.

Prepare for New Federal Regulations

On March 10, 2023, the U.S. Food and Drug Administration (FDA) published a final rule updating the “mammography regulations that were issued under the Mammography Quality Standards Act of 1992 (MQSA) and the Federal Food, Drug, and Cosmetic Act (FD&C Act)” (www.federalregister.gov/documents/2023/03/10/2023-04550/mammography-quality-standards-act).

Starting Sept. 10, 2024, mammography facilities will be required to inform patients of the patient’s breast density. Practices will send patients mammogram reports that describe the breast density as “dense” or “not dense,” whereas mammogram reports sent to healthcare providers will include a breast density assessment according to the BI-RADS categories. The regulation doesn’t take effect for more than a year, but some practices are already starting to provide patients with their results through lay report letters, which offer a simple explanation of the “dense” or “not dense” result.

According to the Centers for Disease Control and Prevention (CDC), approximately 50 percent of women 40 years and older have dense breasts (www.cdc.gov/cancer/breast/basic_info/dense-breasts.htm). The FDA’s rule adjustment is aimed to help prevent, detect, and treat cancer since dense breast tissue has been identified as a risk factor for developing breast cancer. The dense tissue can make it difficult to identify malignancies or other abnormalities on mammograms.