Ensure that your practice’s medical coding for preventive screening mammograms aligns with the most recent guidelines during Breast Cancer Awareness Month in October.
Coding Mammograms for Medicare
The Centers for Medicare & Medicaid Services (CMS) now acknowledges the CPT® mammogram codes, aligning with industry standards. This streamlines the process for coders to accurately document mammogram services. G codes previously used by CMS (G0202, G0204, and G0206) were eliminated effective Jan. 1, 2018.
For 2019 mammogram reporting, utilize these CPT® codes:
● 77063: Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
●77065: Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
● 77066: Diagnostic mammography, including CAD; bilateral
● 77067: Screening mammography, bilateral (2-view study of each breast), including CAD when performed Additionally, include G0279 for Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066), when appropriate.
Appending Modifiers for Laterality
Coders often feel compelled to include modifier 50 for Bilateral procedure or LT/RT for Left/Right sides, assuming these modifiers define the service. However, with mammography codes, neither modifier is necessary because these codes encompass both unilateral and bilateral services.
CGS Medicare, the Medicare Administrative Contractor for Jurisdiction 15 Part B, clarifies:
HCPCS code G0279 holds a bilateral indicator “2” in the Medicare Physician Fee Schedule Database (MPFSDB). This “2” indicator indicates that there’s no special payment adjustment for bilateral procedures. Consequently, bilateral modifiers such as CPT modifier 50 or HCPCS modifiers RT/LT should not be added, and the units field should indicate a quantity of “1.”
Coding Mammography in 2020
Ensure accurate reporting of mammography services by using the appropriate CPT® codes and G0279 when ordered on the service date. Confirm that the service ordered aligns with the code description, as it’s common to mistake screening for diagnostic procedures and the associated tomosynthesis codes.
In 2020, there are ICD-10-CM code adjustments, including new diagnosis codes effective Oct. 1, 2019, such as unspecified lumps in the right and left breasts, overlapping quadrants. While these codes pertain to diagnostic mammograms, it’s essential to review CMS’ National Coverage Determination (NCD) for Mammograms (220.4) before coding. CMS has revised NCD 220.4 multiple times, making it crucial to stay updated through CMS publications for any changes, including significant coding updates related to mammograms. Your Medicare administrative contractor’s website often serves as a reliable source for update announcements.
Coding Mammograms Example
Today, a 67-year-old Medicare patient arrived for her annual mammogram. With a history of dense breast tissue on both sides, she undergoes a diagnostic mammogram rather than a screening one each year. Code the procedure as 77066. Additionally, include G0279 if diagnostic tomosynthesis is conducted.
