Mammography Coding Changes for 2018

Mammography Coding Changes for 2018

Coding for screening mammography furnished to Medicare patients is changed in 2018 as the Centers for Medicare & Medicaid Services (CMS) recognizes three CPT codes added in 2017.

G Codes Out, CPT Codes In

Effective for services rendered on or after Jan. 1, 2018, you will no longer use HCPCS Level II codes G0202, G0204, and G0206 to report screening mammography provided to Medicare patients.

Screening Mammography

CMS now instructs providers to use CPT codes:

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

77066
Diagnostic mammography, including (CAD) when performed; bilateral

77065
Diagnostic mammography, including CAD when performed; unilateral.

Code 77067 is now type of service code 4 Diagnostic radiology, but coinsurance and deductible will continue to be waived.

Screening Digital Breast Tomosynthesis

Also effective for claims with dates of service Jan. 1, 2018 and later, CPT code 77063 Screening digital breast tomosynthesis, bilateral must be billed in conjunction with the primary service mammogram code 77067, or the claim will be denied. Watch the age and frequency edits, too.

Likewise, HCPCS Level II code G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral must be billed in conjunction with the primary service mammogram code 77065 or 77066.

All other coding guidelines remain the same.

 

Sources:

CMS Manual System, Pub 100-04, Transmittal 3844, CR 10181, August 18, 2017; www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf

MLN Matters MM10181 Revised, CR 10181, August 18, 2017; www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10181.pdf

 

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

10 Responses to “Mammography Coding Changes for 2018”

  1. V. Lucero says:

    This information is very helpful!

  2. Monica Hawkins says:

    question: Medicare Mammogram 77067. Our provider does mammogram here at his office. We have been billing TC modifier for doing the procedure mammogram and Radiology is bill for reading of mammogram with 26 modifier. Can we fill for the technical component and reading of radiology with Medicare? Radiologist is not part of our practices.
    Are we require to add FY modifier to mammogram or is the FY modifier only for X-Rays not mammogram?
    I just need like help where to find information.

  3. Lori says:

    Having a debate with unilateral Tom 77063 screening and mod 52. Use 52 or not.

  4. Lori L says:

    Having a debate with unilateral Tom. Screening and modifier 52. Use it or not?

  5. Denise Walsh says:

    If a screening mammography is done on one breast, do we append modifier 52 to CPT 77067? I’m finding conflicting information and our MAC doesn’t specify for Medicare.

  6. Elizabeth Hearne says:

    What about an order for Tomosynthesis? Are providers required to write in 3D mammography on their orders for payment?

  7. JOANNE JOHNSON says:

    can we billed cpt code 76641 tc 50 with a dx code Z12.39

  8. jane yauney says:

    how do you code for implants? screening and diagnostic

  9. jane yauney says:

    what are the codes for mammograms on implants…..both screening and diagnostic?

  10. Nicole says:

    Do we still use these CPT codes if doctor does NOT use CAD?

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