Ob-gyn Coding: Order, Not Implant, Decides Diagnostic vs. Screening Mammogram

Posted on 07. Apr, 2010 by Editor.

Examine Medicare’s coverage guidelines.

Question: My ob-gyn sees a patient who has breast implants or breast augmentation and orders a mammogram. Should I count the mammography as a screening or a diagnostic test?

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Answer: Implants and augmentation don’t equate to a diagnostic mammogram every time. The ordering physician decides whether the patient requires a diagnostic mammogram.

Diagnostic: To be a diagnostic mammogram (such as 77056, Mammography, bilateral), the ob-gyn must …

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How to Code for Screening Mammogram When Radiologist Finds Problem?

Posted on 06. Dec, 2009 by .

Watch out: Results don’t turn screening into diagnostic

Question: A patient presented for a screening mammogram, and the radiologist determined the patient needed an ultrasound for a closer look. The patient returned for that test at a later date. Should I code the original mammogram as 77056 instead of 77057 because the radiologist found a possible problem?

Answer: If the patient presents for and undergoes a screening mammogram, you should code for a screening, even if the radiologist discovers an abnormality. In the case you describe you would report 77057 (Screening mammography, bilateral [2-view film study of each breast]) rather than 77056 (Mammography; bilateral). When the patient returns for the ultrasound, you would report 76645 (Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation). Remember that Medicare requires a separate order for the ultrasound for nonhospital patients.

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Diagnostic Radiology ICD-9 Code Update: New Mammo Code 793.82

Posted on 08. Jul, 2009 by .

New code 793.82 shakes up the whole 793.x range in 2010.

The switch to ICD-9 2010 is only a few short months away; preparing now for a crucial change in diagnostic imaging will put you ahead of the game.

Remember: ICD-9 2010 codes will be appropriate for services performed on or after Oct. 1, 2009.

Dense breasts may require testing beyond a mammogram to confirm no malignancies, and the request for an appropriate code to describe this resulted in 793.82 (Inconclusive mammogram), according to the ICD-9 Committee’s September 2008 meeting agenda.

“The new code may help get insurance companies to pay for additional testing,” says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, with HealthTexas in Dallas. “Prior to the 2010 code, the choices were to bill it as screening or to code dense breasts as an ‘abnormality’” – which they aren’t, she says.

And precisely because these inconclusive mammogram findings are not “abnormal,” ICD-9 2010 will revise the 793.0-793.7 range so that “abnormal” findings aren’t a requirement for using these codes:

• 2009: Nonspecific abnormal findings on radiological and other examination of …

• 2010: Nonspecific (abnormal) findings on radiological and other examination of …

Codes 793.89 and 793.99 will have the same change, adding parentheses:

• 2010: 793.89 – Other (abnormal) findings on radiological examination of breast

• 2010: 793.99 – Other nonspecific (abnormal) findings on radiological and other examination of body structure.

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