Radiology Coding Alert

Question: What are the correct ICD-9 codes that we can report for a preventive ultrasound on the breast? Preventive ultrasound of the breast is generally reported with 76645 and insurance very often processes it to deductible. The reason cited is that we do not use the correct preventive code. Please help.

North Carolina Subscriber

Answer: When your radiologist does not formulate a new diagnosis from the breast ultrasound, you should report the ICD-9 codes that represent the symptoms that prompted the investigation or the imaging findings. Although your carrier won’t reimburse the ultrasound for an asymptomatic patient who also did not have some imaging indication for the ultrasound, check with the referring physician and confirm any documented symptoms such as pain, an abnormal mammogram, or any other symptom or finding. A frequent reason for ultrasound of the breast is an abnormality on a preceding mammogram (either screening or diagnostic).

You can collect reimbursement for breast ultrasound, 76645 (Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation) for diagnoses which include 239.2 (Neoplasms of unspecified nature; bone, soft tissue, and skin), 610.0 (Solitary cyst of breast), 611.4 (Atrophy of breast), 793.80 (Unspecified abnormal mammogram), 922.0 (Contusion of breast), and others.

If your radiologist documents a specific diagnosis after the investigation, you should always report the confirmed diagnosis instead of the symptoms. You can choose V76.19 (Other screening breast examination) for this case.