Radiology Coding Alert

Question: If a mammography patient has a benign biopsy, how long before we code her routine mammogram as a screening exam?


Wisconsin Subscriber

Answer: Quick answer--code what the doctor ordered. Like many carriers, Wisconsin Physicians Service covers a diagnostic mammogram even on an asymptomatic patient if the ordering physician believes it's necessary because of the patient's history and other factors. Indicators may include a personal history of biopsy-proven benign breast disease (V15.89, Other specified personal history presenting hazards to health; other).

If you have a physician's order for a diagnostic mammogram, report 76090 (Mammography; unilateral) or 76091 (... bilateral). For a screening mammogram, report 76092 (Screening mammography, bilateral [two-view film study of each breast]).

Remember: If the provider documents computer- aided detection of a lesion and adequate review, add +76082 (Computer-aided detection [computer algorithm analysis of digital image data for lesion detection] with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography) to 76090 and 76091. Or add +76083 (... screening mammography) to claims for 76092.