Radiology Coding Alert

Question: A 65-year-old female Medicare patient who previously underwent a unilateral mastectomy for breast cancer presented to our radiology practice for an annual mammography.

Can we assign a screening mammography for the visit?

Indiana Subscriber

Answer: No, you cannot assign a screening mammography code, such as 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed), to report the mammography examination.

According to the Centers for Medicare & Medicaid Services (CMS) Medicare National Coverage Determinations Manual, section 220.4, “A screening mammography is a radiologic procedure furnished to a woman without signs or symptoms of breast disease, for the purpose of early detection of breast cancer, and includes a physician’s interpretation of the results of the procedure.”

As you indicated, the patient has a history of breast cancer, which means the mammography exam can only be reported using 77065 (Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral).