Radiology Coding Alert

Plus: What is focal asymmetry?

As any mammogram coder can tell you, diagnosis and screening are not the only applications for mammograms. Your physician may also use mammography to guide the placement of wires, needles, clips, radioactive seeds, and other devices in the breast. In such situations, you must keep a count on how many lesions your physician treated.

For mammographic guidance, you’ll report code 19281 (Placement of breast localization device[s] [eg, clip, metallic pellet, wire/needle, radioactive seeds], percutaneous; first lesion, including mammographic guidance) for the first lesion and code +19282 (Placement of breast localization device[s] [eg, clip, metallic pellet, wire/needle, radioactive seeds], percutaneous; each additional lesion, including mammographic guidance [List separately in addition to code for primary procedure]) for each additional lesion that your physician treats.  

Medicare assigns the medically unlikely edit number of “2” to +19282, so your practice can typically only report one unit of 19281 and two units of +19282 on any particular claim.

Understand Focal Asymmetry

Suppose your physician documents focal asymmetry on a mammogram. Since this is an atypical diagnosis, you might be stumped, but the correct ICD-10 code for this is R92.2 (Inconclusive mammogram).

What is a focal asymmetry?  Your physician will document an asymmetry on a mammogram when there is an increased density in one of the breast on one or both standard mammographic views but there isn’t any evidence of a discrete mass. Both benign and malignant lesions in the breast can lead to asymmetry.

Your physician may document an asymmetry which is stable and remains unchanged over the years. This type of asymmetry does not need any further investigation. An asymmetry that is seen on both views of the breast may call for further investigation. Summation shadows are typically seen on one view only and disappear when the view is repeated. Your physician may request an ultrasound if the mammogram shows a summation shadow.

Know Your Other Diagnosis Coding Options

Under ICD-10, you’ll assign a screening code as the primary diagnosis for a screening mammogram. However, ICD-10 does not distinguish between high risk patients like ICD-9 did, so you only have one diagnosis code to report for the screening mammography visits: Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast). Also include any relevant clinical history or clinical findings as a secondary diagnosis.

Tip: In ICD-10, you will find Z12.31 in the Index under “Mammogram, routine” or “Screening, neoplasm, breast, routine mammogram.”

For a patient with a family history of breast cancer, submit the claim with code Z12.31 followed by Z80.3 (Family history of malignant neoplasm of breast).

You cannot submit a diagnostic mammogram with screening code Z12.31. Instead, you need to use the radiologist’s definitive findings to help choose a code. In a case of inconclusive findings, report the signs and/or symptoms that necessitated the order of a diagnostic mammogram.

Example: If calcification is seen in the patient’s screening mammogram and the radiologist documents that the calcifications are most likely vascular in nature, he could recommend the patient continue routine annual screening mammograms. The diagnosis code for this would be R92.1 (Mammographic calcification found on diagnostic imaging of breast).

When you still coded with ICD-9, you had separate diagnoses for breast nodule (793.89) and breast mass (611.72). In ICD-10, both breast mass and breast nodule are reported with the same code: N63 (Unspecified lump in breast). Rely on the ICD-10-CM Index to locate the appropriate codes for any mammographic findings.