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Radiology Coding Alert

Reader Questions:

Base Breast MRI Dx on Documentation

Published on Sun Jun 18, 2006

Question: Are there any rules about reporting a  diagnosis code for a breast MRI?

Massachusetts Subscriber Answer: The basic ICD-9 Codes rule applies -- report the code that describes the documented diagnosis, sign or symptom.
 
If a physician orders the breast MRI because of a lump or mass in the breast and the radiologist does not document a different diagnosis, you must report 611.72 (Lump or mass in breast).
 
If you perform an MRI of the breast for screening purposes, report V76.19 (Other screening breast examination), but keep in mind that payers typically don’t cover screening exams.
 
Note: Payers may have specific coverage guidelines for breast MRI. For example, Massachusetts Blue Cross states that it covers breast MRI under its individual consideration program when the test evaluates the extent of ill-defined breast cancer or “to evaluate a suspicious clinical finding, which is not clearly defined or localized after mammography and ultrasound.”
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