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Radiology Coding Alert

Please Payers With These Dx Codes for 76090-76092

Published on Tue Apr 01, 2003

Don't identify a screening mammography from a diagnostic mammography and then blow it by linking the procedure code to a noncovered diagnosis code. When reporting a bilateral screening mammogram, 76092 (Screening mammography, bilateral [two view film study of each breast]) or G0202 (Screening mammography, producing direct digital image, bilateral, all views), for a low-risk patient, link the procedure code to V76.12 (Other screening mammogram).

For a high-risk patient, link the appropriate screening mammography procedure code to V76.11 (Screening mammogram for high-risk patient). You should also account for any additional pertinent information when applicable with additional ICD-9 V codes, i.e., V10.3 (Personal history of malignant neoplasm; breast), V15.89 (Other specified personal history presenting hazards to health; other), or V16.3 (Family history of malignant neoplasm; breast).

Choosing ICD-9 Codes for diagnostic mammograms is not as easy because covered diagnosis codes vary from carrier to carrier. Reliable ICD-9 codes for 76090 (Mammography; unilateral), 76091 ( bilateral), G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views) and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views) include but are not limited to:
174.0-174.9 Malignant neoplasm of female breast
198.81 Secondary malignant neoplasm of other specified sites; breast
238.3 Neoplasm of uncertain behavior of other and unspecified sites and tissues; breast
239.3 Neoplasms of unspecified nature; breast
451.89 Phlebitis and thrombophlebitis of other sites, other
610.0-611.79 Disorders of breast
611.8 Other specified disorders of breast
675.10-675.14 Infections of the breast and nipple associated with childbirth; abscess of breast
675.20-675.24 ... nonpurulent mastitis
793.80 Abnormal mammogram, unspecified
793.81 Mammographic microcalcification
793.89 Other abnormal findings on radiological examination of breast
V10.3 Personal history of malignant neoplasm; breast.    
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