lilleyea
Networker
I need some help please:
First question is if diagnosis Z12.31 (encounter for screening mammogram for malignant neoplasm of breast) can be used on an office visit...the patient had her annual mammogram and is following-up with the doctor several weeks later to review the results of the mammogram and also have a yearly physical breast exam. I would think the office visit would be coded with Z12.39 (encounter for other screening for malignant neoplasm of breast), and only the actual mammogram test would be coded with Z12.31, but since the mammogram was ordered and reviewed by the same doctor maybe Z12.31 is ok?
Next question is if a patient has a history of breast cancer and has been cancer free for several years, and is coming into the office for an annual breast screening with no signs or symptoms, do you code the Z12.3- for the screening (from question 1), or do you code Z08 (encounter for follow-up examination after completed treatment for malignant neoplasm), or can you code both? My logic is that the patient is asymptomatic and per the coding guidelines for screening codes "Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those whose test positive for the disease", which at this time the patient is seemingly well and is testing for the disease. Then on the other hand the coding guidelines for follow-up codes state "The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists.", which also applies to this patient. So both diagnosis are supported, however it doesn't seem right to use them both, and there are no excludes notes between the two codes.
Final question is if the answer to the above question is to use only Z08 for the follow-up, does this mean that once a patient is diagnosed with breast cancer they can never again use the screening diagnosis? CMS contractor First Coast Service Options has an LCD for screening and diagnostic mammograms that states this:
Diagnostic Mammography
A diagnostic mammography is a radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, or a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease, and includes a physician’s interpretation of the results of the procedure.
Diagnostic mammogram(s) are allowed for the following indications:
•the patient is under the care of the referring/ordering physician or qualified non-physician practitioner;
•there are signs and/or symptoms suggestive of malignancy (mass, some types of spontaneous nipple discharge or skin changes);
•there are possible radiographic abnormalities detected on screening mammography;
•there is short interval follow-up (less than one year) necessary for unresolved clinical/radiographic concerns; or
•follow-up of established history of a malignancy is necessary
Diagnostic breast evaluation may be indicated in cases of a personal history of malignancy and in cases of benign biopsy-proven breast disease. These diagnoses should not, however, routinely warrant a diagnostic mammography.
So the part at the end is what gets me...it states that these diagnoses (personal history of malignancy and benign biopsy-proven breast disease) should not routinely warrant a diagnostic mammogram. So then does that mean that the screening would then be appropriate for a routine annual mammogram?
I am so confused. Thank you to anyone who attempts to help me!!!
First question is if diagnosis Z12.31 (encounter for screening mammogram for malignant neoplasm of breast) can be used on an office visit...the patient had her annual mammogram and is following-up with the doctor several weeks later to review the results of the mammogram and also have a yearly physical breast exam. I would think the office visit would be coded with Z12.39 (encounter for other screening for malignant neoplasm of breast), and only the actual mammogram test would be coded with Z12.31, but since the mammogram was ordered and reviewed by the same doctor maybe Z12.31 is ok?
Next question is if a patient has a history of breast cancer and has been cancer free for several years, and is coming into the office for an annual breast screening with no signs or symptoms, do you code the Z12.3- for the screening (from question 1), or do you code Z08 (encounter for follow-up examination after completed treatment for malignant neoplasm), or can you code both? My logic is that the patient is asymptomatic and per the coding guidelines for screening codes "Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those whose test positive for the disease", which at this time the patient is seemingly well and is testing for the disease. Then on the other hand the coding guidelines for follow-up codes state "The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists.", which also applies to this patient. So both diagnosis are supported, however it doesn't seem right to use them both, and there are no excludes notes between the two codes.
Final question is if the answer to the above question is to use only Z08 for the follow-up, does this mean that once a patient is diagnosed with breast cancer they can never again use the screening diagnosis? CMS contractor First Coast Service Options has an LCD for screening and diagnostic mammograms that states this:
Diagnostic Mammography
A diagnostic mammography is a radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, or a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease, and includes a physician’s interpretation of the results of the procedure.
Diagnostic mammogram(s) are allowed for the following indications:
•the patient is under the care of the referring/ordering physician or qualified non-physician practitioner;
•there are signs and/or symptoms suggestive of malignancy (mass, some types of spontaneous nipple discharge or skin changes);
•there are possible radiographic abnormalities detected on screening mammography;
•there is short interval follow-up (less than one year) necessary for unresolved clinical/radiographic concerns; or
•follow-up of established history of a malignancy is necessary
Diagnostic breast evaluation may be indicated in cases of a personal history of malignancy and in cases of benign biopsy-proven breast disease. These diagnoses should not, however, routinely warrant a diagnostic mammography.
So the part at the end is what gets me...it states that these diagnoses (personal history of malignancy and benign biopsy-proven breast disease) should not routinely warrant a diagnostic mammogram. So then does that mean that the screening would then be appropriate for a routine annual mammogram?
I am so confused. Thank you to anyone who attempts to help me!!!