Oncology & Hematology Coding Alert

Question: CPT 2003 states that coders should report add-on code 76085 with the bilateral mammography codes 76091 and 76092. Why can't we use this code with the unilateral mammography code 76090?

Oregon Subscriber Answer: The AMA's CPT Changes 2003: An Insider's View states, "CPT add-on code +76085 (Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography [list separately in addition to code for primary procedure]) was editorially changed to delete 'screening' from the code descriptor in order to report computer-aided detection (CAD) when used in conjunction with a screening or diagnostic mammography.  

"In addition, correlating cross-references following codes 76085, 76091 (Mammography; bilateral), and 76092 (Screening mammography, bilateral [two view film study of each breast]) were revised and added to instruct the user on appropriate reporting use of these codes in conjunction with other services."
 
Although the AMA did not issue a statement regarding why 76085 is only billable with the bilateral mammography codes, the code may have an "implied" bilateral status.
 
Ask your carrier which code it prefers for digitization during unilateral mammography. Some insurers request that you report 76085-52 (Reduced services), while others stand by the HCPCS code G0236 (Digitization of film radiographic images with computer analysis for lesion detection, or computer analysis of digital mammogram for lesion detection, and further physician review for interpretation, diagnostic mammography [list separately in addition to code for primary procedure]).