Revenue Cycle Insider

Question: A patient who previously underwent a mastectomy due to breast cancer came to our office for a screening mammogram. Do I need to add a modifier to CPT^® 77067 since in this case, only the remaining breast was being imaged?

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Answer: Yes, according to Ruby O’Brochta-Woodward, BSN, CPC, CPMA, CDEO, CEMC, CPCO, CPB, COSC, CSFAC, CPC-I, a coding educator for Twin Cities Orthopedics/Revo Health. “When a screening mammogram is done unilaterally, you will need to add modifier 52 [Reduced services],” she explained during her presentation “Radiology 101” at the La Crosse, Wisconsin, AAPC chapter meeting in November.

So, in this case, 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed) will need the modifier appended to it to indicate to the payer the physician performed the procedure on one breast, not two.

Hint: Depending on which breast was removed, you can also add ICD-10-CM code Z90.11 (Acquired absence of right breast and nipple) or Z90.12 (Acquired absence of left breast and nipple) to the claim for added clarification for the payer.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC