Wiki Denials on Unilatera Breastl Mammogram Screenings with Tomosynthesis

[TReed21]

We have been getting denial on patients that come in for annual mammogram screenings with Tomosynthesis. These patients have had a unilateral mastectomy. For example, the patient came in for a Mammogram screening with Tomosynthesis of the left breast we would code is as follows:

77067-52, LT, Z85.3 (hx of breast CA), Z90.11 (absence of right breast)

Is this correct? This is how we coded them, and recently we have been getting denials. Please help!!

 

[JCaillouet]

Before I take a stab at a response:

What's the denial?

 

[jbaird]

If a screening mammogram was ordered and it has been 1 year since the last screening mammogram you would code 77067-52. You will need to use the screening ICD-10 Z12.31 as your first code, then list the history of breast cancer second.

You also indicate tomosynthesis was done. If this was also ordered, performed & documented in the report please look at using 77063-52 in addition to your main mammogram code.

We have been getting denial on patients that come in for annual mammogram screenings with Tomosynthesis. These patients have had a unilateral mastectomy. For example, the patient came in for a Mammogram screening with Tomosynthesis of the left breast we would code is as follows:

77067-52, LT, Z85.3 (hx of breast CA), Z90.11 (absence of right breast)

Is this correct? This is how we coded them, and recently we have been getting denials. Please help!!