I have not been coding the "abnormal mammogram" but just the cyst. Aetna would have paid for the code for "abnormal mammogram" but not for the cyst.
I did a random search for Aetna and found this:
"Aetna considers breast MRI experimental and investigational for all other indications, including any of the following, because there is insufficient scientific evidence to support its use:
To confirm implant rupture in symptomatic individuals whose ultrasonography shows rupture, especially with implants more than 10 years old (ultrasound sufficient to proceed with removal); or
To diagnose fat necrosis post-breast reduction surgery; or
To differentiate benign from malignant breast disease, especially clustered micro-calcifications; or
To differentiate cysts from solid lesions (ultrasound indicated); or
To evaluate breasts before biopsy in an effort to reduce the number of surgical biopsies for benign lesions; or
Surveillance of asymptomatic individuals with breast cancer who have completed primary therapy and who are not at high genetic risk of breast cancer; or
To provide an early prediction of response to adjuvant breast cancer chemotherapy in guiding choice of chemotherapy regimen; or
Dermatomyositis as an indication for use of MRI for breast cancer screening; or
To screen for breast cancer in members with average risk of breast cancer; or
To screen BRCA-positive men.
ICD-10 codes not covered for indications listed in the CPB:
D24.1 - D24.9 Benign neoplasm of breast
D48.60 - D48.69 Neoplasm of uncertain behavior of breast
M33.00 - M33.99 Dermatopolymyositis
N60.01 - N60.09 Solitary cyst of breast
N60.11 - N60.19 Diffuse cystic mastopathy
N60.21 - N60.29 Fibroadenosis of breast
N60.81 - N60.89 Other benign mammary dysplasias
N64.1- Fat necrosis of breast
N64.9 Disorder of breast, unspecified
R92.0 Mammographic microcalcification found on diagnostic imaging of breast
R99 Ill-defined and unknown cause of mortality"
This is covered if criteria are met: "R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast"
http://www.aetna.com/cpb/medical/data/100_199/0105.html
The date on the document is old, but there's been very recent revisions that you can see when you click on the box.
I don't know if this will be helpful, but there's some coding examples.
https://rccb.org/icd-10-cm-codes-for-mammograms