Radiology Coding Alert

Question: What code should I use for a unilateral screening mammogram? The documentation indicates the patient has had one of her breasts removed, but the code descriptor for a screening mammogram calls out a bilateral study. Do I need to include a modifier?

Massachusetts Subscriber

Answer: When your radiologist performs a screening mammogram, you will report 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed). In this case, you can report the same code for a patient who only has one breast. However, because the code descriptor for 77067 states “bilateral,” you will need to append a modifier to the code. Using modifier 52 (Reduced services) allows your report to reflect the screening procedure was performed on only one breast.

Additionally, some payers may not require the modifier 52 for reporting a unilateral screening mammogram. Your radiology practice should check with local contractors and other 3rd-party payers to determine the necessity of modifier 52 when coding CPT^® code 77067 for a screening mammogram.