Radiology Coding Alert

Question: We have a patient with a history of breast malignancy scheduled to receive a screening mammogram. Should the order be sent back to have the radiologist perform a diagnostic mammogram instead?

Colorado Subscriber

Answer: Patients with a history of malignancy are not required to receive diagnostic mammograms following complete eradication of the malignancy. The American College of Radiology (ACR) further explains that no such guidelines exist in their Breast Imaging Frequently Answered Questions (FAQ) section:

• “No, Medicare does not have a specific requirement that a patient with a history of mastectomy must revert back to a screening mammography study after a set number of negative diagnostic studies or after a specified number of years post mastectomy. CMS allows the attending physician and the patient the flexibility to choose whether they want to continue with a diagnostic mammogram or revert back to the screening process.”