Radiology Coding Alert

Question: A patient presents to our office for a routine screening mammogram (not digital). Our radiologist sees a cyst and wants a breast ultrasound performed. How should we code the mammogram? Can we still call this a screening mammogram?

Tennessee Subscriber

Answer: The mammogram is still a screening mammogram regardless of the findings. So you should report 77057 (Screening mammography, bilateral [2-view film study of each breast]), the appropriate V-code (V76.11, Screening mammogram for high-risk patient; or V76.12, Other screening mammogram) and the appropriate cyst ICD-9 code, based on the documentation.

Watch for: Medicare Claims Processing Manual chapter 18, section 20.6.B, explains you may also assign a diagnostic code for additional films taken the same day. You don't mention additional films, but if you do perform them, you should report 77057, 77055-GG (Mammography; unilateral; Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day), assuming the diagnostic is unilateral.

Also, in the office setting, you'll need a treating physician to order the breast ultrasound (US) (76645, Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation). Your diagnosis for the US depends on what the radiologist finds and documents, but if it's normal or nonspecific, turn to 793.8X (Nonspecific abnormal findings on radiological and other examination of body structure; breast ...).

Digital do: If you had performed digital mammograms, you would not use 77057 or 77055. Instead, you would report G codes, such as screening code G0202 (Screening mammography, producing direct digital image, bilateral, all views) and the appropriate diagnostic code with GG appended (such as G0206, Diagnostic mammography, producing direct digital image, unilateral all views).