CPT code for digital screening mammogram GuideMammogram is done to check any abnormal finding present in the breast area. In US, due to breast cancer, female residents are periodically goes for a screening exam. This exam is just a routine checkup to be aware of any preventive measure for breast cancer. This screening exam is called as screening mammogram. CPT code for digital screening mammogram is frequently used in medical coding. Since, the exam is done periodically hence we get a lot of reports of screening mammogram. Their are new CPT codes for diagnostic and screening mammogram in 2017. We will be having bundle CPT codes this time, so let us checkout the new CPT codes changes in mammogram in Radiology facility.

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New revised CPT codes from 2018 for Mammogram

New codes were introduced in 2017 for diagnostic and Screening Mammogram. These new CPT codes are bundled with computer-aided-detection (CAD) and mammography.  The old CAD and mammography codes 77051, 77052, 77055, 77056, and 77057 will be deleted in 2017.  But, in 2018   the HCPCS Level II G codes G0202, G0204 and G0206 will be discontinued to be used in 2018 for Medicare patients. Below are the new CPT codes in 2018 for diagnostic and Screening Mammogram all payers.

77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral

77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

For claims with dates of service January 1, 2017, through December 31, 2017, report HCPCS codes G0202, G0204, and G0206. For claims with dates of service on or after January 1, 2018, report CPT codes 77067, 77066, and 77065 respectively.

Deleted HCPCS codes for Mammogram in 2018

G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

G0204 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral

G0206 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

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Deleted CPT codes for digital Screening Mammogram & Diagnostic Mammogram

The patient, which has any abnormal finding in breast like breast mass or lump, calcification, micro calcification, cyst in breast etc. are generally goes for Diagnostic mammogram. If the physician is suspicious about the abnormal finding then they can go for breast biopsy also. The biopsy procedure will help to know the exact nature of the abnormal finding present in breast. Hence, the difference between the both diagnostic and screening mammogram is very simple, during screening exam present do not have any abnormal or suspicious finding in breast, on the contrary diagnostic exam is done when there are any abnormal or suspicious finding are present in breast. Now, let checkout the CPT code for digital screening mammogram and diagnostic mammogram.

Procedure Description Digital Exam CPT code Bilateral Digital Exam CPT code Unilateral Non-digital exam CPT code Bilateral Non-digital exam CPT code Unilateral  
Screening Mammogram 77067 77067-52 77067 77067-52  
Diagnostic Mammogram 77066 77065 77066 77065  

 

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ICD 9 & 10 codes used with CPT code for digital screening mammogram

There are only two icd codes used with Screening mammogram, V76.12 and V76.11. These two V codes are used for High-risk patient (V76.11) and Normal patient (V76.12). The high-risk patients are those, which have any past history or family history of breast cancer. Normal Patients do not have any history or family history of breast cancer. These two V codes should be used with CPT code for digital screening mammogram. The common icd codes used with diagnostic mammogram are breast mass or lump (611.72), abnormal mammogram (793.80), breast calcification (793.89) and breast micro calcification (793.81).

ICD 10 codes

V76.12 – Z12.31 Encounter for screening mammogram for malignant neoplasm of breast

V76.11- Z12.31  Encounter for screening mammogram for malignant neoplasm of breast

611.72 – N63      Unspecified lump in breast

793.80 – R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast

793.81 – R92.0Mammographic microcalcification found on diagnostic imaging of breast

793.89 – R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast

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CAD code bundled with CPT code for Digital Screening Mammogram

The CAD is referred as Computer Aided Detection. It is generally used with digital diagnostic and screening mammogram. The CAD is mostly used with mammogram. The CAD code is now bundled with diagnostic mammogram and with screening mammogram procedure codes from 2017.

Physician Quality Reporting System (PQRS) used along with Screening Mammogram

Measure 146 

CPT Codes
Code Modifier POS Description
77067     Screening mammography, bilateral (2-view study of each breast)
3340F     Mammogram assessment category of “incomplete: need additional imaging evaluation” documented (RAD)
3340F     Mammogram assessment category of “incomplete: need additional imaging evaluation” documented (RAD)
3341F     Mammogram assessment category of “negative,” documented (RAD)
3341F     Mammogram assessment category of “negative,” documented (RAD)
3342F     Mammogram assessment category of “benign,” documented (RAD)
3342F     Mammogram assessment category of “benign,” documented (RAD)
3343F     Mammogram assessment category of “probably benign,” documented (RAD)
3343F     Mammogram assessment category of “probably benign,” documented (RAD)
3344F     Mammogram assessment category of “suspicious,” documented (RAD)
3344F     Mammogram assessment category of “suspicious,” documented (RAD)
3345F     Mammogram assessment category of “highly suggestive of malignancy,” documented (RAD)
3345F     Mammogram assessment category of “highly suggestive of malignancy,” documented (RAD)
3350F     Mammogram assessment category of “known biopsy proven malignancy,” documented (RAD)
3350F     Mammogram assessment category of “known biopsy proven malignancy,” documented (RAD)
HCPCS Codes
Code Modifier POS Description
77067     Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed

 

PQRS Measure 225

 

Code Modifier POS Description
77067     Screening mammography, bilateral (2-view study of each breast)
7025F 8P   Patient information entered into a reminder system with a target due date for the next mammogram (RAD)
7025F     Patient information entered into a reminder system with a target due date for the next mammogram (RAD)
7025F 1P   Patient information entered into a reminder system with a target due date for the next mammogram (RAD)
7025F     Patient information entered into a reminder system with a target due date for the next mammogram (RAD)
7025F 8P   Patient information entered into a reminder system with a target due date for the next mammogram (RAD)