Radiology Coding Alert

Question: What is the ICD-9 Code for a normal breast ultrasound?

Vermont Subscriber


Answer: If the radiologist does not formulate a new diagnosis from the ultrasound, you should report the ICD-9 Codes that represent the symptoms or imaging findings that prompted the test. Although your carrier won't reimburse the ultrasound for an asymptomatic patient who also did not have some imaging indication for the ultrasound, the referring physician probably documented symptoms such as pain, an abnormal mammogram, or something more comprehensive. A frequent reason for ultrasound of the breast is an abnormality on a preceding mammogram (either screening or diagnostic).

According to National Heritage Insurance Company's breast ultrasound policy (a Part B Carrier in Vermont), you can collect reimbursement for breast ultrasound (76645, Ultrasound, breast[s] [unilateral or bilateral], B-scan and/or real time with image documentation) for more than 20 diagnoses, such as:

239.2 - Neoplasms of unspecified nature; bone, soft tissue, and skin

610.0 - Solitary cyst of breast

611.4 - Atrophy of breast

793.80 - Nonspecific abnormal findings on radiological and other examination of body structure; breast; abnormal mammogram, unspecified

922.0 - Contusion of trunk; breast.

If the radiologist diagnoses a more specific problem, you should always report the confirmed diagnosis instead of the symptoms.