Wiki Who can help on mammography coding?

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ssullivan

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I work in outpatient radiology private practice. Wondering who may have expertise in coding for mammography, more specifically, for patients with implants. Most insurance companies cover yearly screening mammograms. As a rule, when a patient comes in who has implants, we always bill out for a diagnostic mammogram because the number of films taken are that of a double screening. Is this an across-the-board practice for mammography with people with implants. And, as long as the patient has no other symptoms or diagnosis, how would it be coded? We are finding that many, or most, patients with implants expect a completely covered "screening" yearly mammogram, and when it comes to the insurance perspective, some insurance companies do not see it that way and leave a deductible or coinsurance to the patient because it is being billed as a diagnostic mammogram? Is this a common problem, or is there something we are not aware of? Normally, with no other indications, we bill out V15.89. Any feedback on this would be greatly appreciated.
 
V15.89 is a secondary only dx code, also I am having an issue with using that code. If it were hazardous to have breast implants, then they would not allow physicians to put them in. The correct code would be a V76.1x code. It is a screening whether cover by the patient's plan or not.
 
I guess that is part of my question. I was told that if you code a diagnostic procedure with the screening code(V76.11-screening for high risk patients) it would be denied by insurance. Is that a legitimate way to code patients with implants for a yearly screening, as they are high risk patients?
 
I have not seen any literature that says the implant makes them high risk, however if they have a hx of breast cancer then yes. You should not be coding a diagnostic mam it is still screening. We did these every year for our post breast ca patient with implants and never coded the mam as diagnostic, always screening.
 
Here is a quote from one of my articles on breast cancer and high risk:
Breast implants

Several studies have found that breast implants do not increase breast cancer risk, although silicone breast implants can cause scar tissue to form in the breast. Implants make it harder to see breast tissue on standard mammograms, but additional x-ray pictures called implant displacement views can be used to examine the breast tissue more completely.
 
So if we are taking 8 films as a standard for implants in our practice and scheduling double the amount of time for a patient than a screening which with we take the minimum of 4 films, we should still be billing for a screening? Also you are referring to patients who have had breast cancer, but what about patients who have implants for cosmetic reasons only. If they have had breast cancer then we code with breast cancer or history thereof. The patients that I am referring to are ones that have no history of breast cancer.
 
It is still screening, you need a sign or symptom for a diagnostic, and as you have pointed out there is nothing wrong with the patient nor is anything suspected of being wrong.
 
Thank you for you input. If you have any other resources that you could direct me to, not just on this issue, but any other for diagnostic radiology that would be greatly appreciated. Thank you again.
 
I agree with Debra on all of her points. I have the same issue at our facility when a patient comes in that have implants and they are there for there yearly mammo. Unless the patient is haveing problems with those implants then the rule goes a screening is a screening is a screening.

I have went round and round with our Radiology Dept. and they will still put the charge in for a Diagnostic mammo, so then I have to send it up for a charge correction to reflect a screening before the account gets coded.
 
Do you code for the screening mammography breast implants twice since it is 8 views versus 4? Or would you use a 22 modifiere to indicate the additional work?
 
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