Radiology Coding Alert

Question: A patient presented for a screening mammogram. During the initial interview with the technologist, the patient mentioned that she had a breast cyst aspiration seven months earlier. Would the current mammogram be coded as 76092, since it falls within the one-year period and no biopsy was performed, with a diagnosis of V76.12? The outcome of the exam was negative.

Kansas Subscriber

Answer: Although the patient has had a previous problem, the ordering physician intended for the exam to be screening. The correct code would be 76092 (screening mammography, bilateral [two view film study of each breast]) with the diagnosis of V76.12 (other screening mammogram) based on the order from the attending physician.

If the previous breast cyst aspiration was performed without imaging guidance or with ultrasound guidance, there should be no problem with the screening test being performed within 12 months of the aspiration (as long as the patient has not had another screening exam in the last 12 months). If, however, the aspiration was performed with a diagnostic mammogram, there will likely be a problem with payment for a screening mammogram within 12 months of a previous mammogram, at least within the Medicare program.

To code for a diagnostic mammogram, the attending physician must specifically order a diagnostic study and provide the appropriate patient history, symptoms or complaints. Alternately, the radiologist may identify an abnormality and convert the screening mammogram to a diagnostic mammogram.