Internal Medicine Coding Alert

Don't differentiate a screening mammography from a diagnostic mammography and then blow it by linking the procedure code to a noncovered diagnosis code.

When ordering a bilateral screening mammogram, 76092 (Screening mammography, bilateral [two view film study of each breast]) or G0202 (Screening mammography, producing direct digital image, bilateral, all views), for a low-risk patient, link the procedure code to V76.12 (Other screening mammogram).

For a high-risk patient, link the appropriate screening mammography procedure code to V76.11 (Screening  mammogram for high-risk patient). You should also account for any additional pertinent information when applicable with additional ICD-9 V codes, i.e., V10.3 (Personal history of malignant neoplasm; breast), V15.89 (Other specified personal history presenting hazards to health; other) or V16.3 (Family history of malignant neoplasm; breast).

Choosing ICD-9 codes for diagnostic mammograms is not as easy because covered diagnosis codes vary from carrier to carrier. Reliable ICD-9 codes for 76090 (Mammography, unilateral), 76091 ( bilateral), G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views) and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views) include but are not limited to: