Take Your Mammography Coding From Negative to Positive With This Guide
Find out if screenings are for everyone. As a radiology coder, you’re sure to see your fair share of mammography exams in your workflow. Regardless of whether you’re freshly credentialed or have decades of coding experience under your belt, several factors can still cause confusion. With this guide, you can reinforce your understanding of these common exam and diagnosis codes. Read on to master mammography coding to boost your practice’s bottom line. Separate Screening From Diagnostic Mammography Exams A patient who is not exhibiting or experiencing signs or symptoms of breast disease is eligible for a screening mammography exam. When a radiologist performs a screening mammography, you’ll assign 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed) to report the procedure. On the other hand, diagnostic mammography exams are needed when the patient has a history of breast cancer or if the screening mammography is insufficient for the radiologist to fully evaluate the patient’s breasts for abnormalities. Use the following codes for diagnostic mammography exams: Assign 77065 for a diagnostic mammography exam performed on either the left or right breast and report 77066 for a diagnostic mammography exam of both breasts. Furthermore, you can only report 77067 for female patients. Male patients who undergo a mammography do so because they are exhibiting signs or symptoms, such as feeling a lump in the breast tissue, which means the imaging exam will be a diagnostic mammography. Dive Into Diagnosis Codes to Report Medical Necessity Selecting the correct ICD-10-CM code is crucial to ensuring the breast examination procedure is reimbursed. You’ll refer to different chapters in the ICD-10-CM code book depending on medical necessity for the imaging exam. Use only Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast) when the patient presents for a screening mammography when no abnormalities are detected. You’ll need to assign other codes if the radiologist documents abnormalities on the images that require further investigation. Turn to the N63.- (Unspecified lump in breast) code category when the provider identifies an abnormality in the breast tissue while interpreting the mammograms. Both N63.1- (Unspecified lump in the right breast) and N63.2- (Unspecified lump in the left breast) require 5th characters to specify in which quadrant the abnormality is located. Example: A patient presents for an annual screening mammography. Upon review of the images, the radiologist documents a finding of an abnormality at 5:00 in the left breast. For this example, you’ll use N62.23 (Unspecified lump in the left breast, lower outer quadrant) to report the abnormality. Physicians will often use hours on a clock face to indicate the location of the abnormality. Using the clock face analogy allows you to determine the quadrant of each breast — outer indicating away from the center of the body and inner indicating closer to the body’s center. In the example above, 5:00 on the left breast lands the abnormality in the lower outer quadrant, whereas 5:00 on the right breast would fall under the lower inner quadrant. Use Breast Density Codes for Further Specificity Radiologists use a classification system known as Breast Imaging-Reporting and Data System (BI-RADS) to examine and explain the results of breast imaging examinations. The results are categorized on a 0 to 6 scale: At the same time, BI-RADS categorizes breast tissue into four categories from A to D. Category A contains almost entirely fatty tissue and nearly no dense tissue. Category B means the breast contains still mostly nondense or fatty tissue but can have a few areas of fibroglandular density. Breasts that fall under category C contain an almost equal amount of dense and nondense tissue. Category D breasts are almost entirely dense tissue and the density can reduce the mammogram’s sensitivity. Based on the BI-RADS results, you may also need to include one of the following R92.3- (Mammographic density found on imaging of breast) codes to indicate the provider’s need for further testing: Each of the above codes require a 6th character to complete the code, and that final character is used to specify laterality. You’ll use “1” for the right breast, “2” for the left breast, or “3” for a bilateral diagnosis. You’ll assign R92.30 (Dense breasts, unspecified) if the provider’s documentation doesn’t indicate a specific type of breast tissue density. This code should be used rarely since the code set includes the four code subcategories listed above, which allow you to assign diagnosis codes to match the documented breast tissue density. “Fatty breast tissue density is found in about 10 percent of women, fibroglandular and heterogenous breast tissue densities are both found in about 40 percent of women, and extremely dense breast tissue is found in about 10 percent of women,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services. Break Down Breast MRI Procedures A healthcare provider may order a breast MRI when the patient has dense breast tissue, which makes it difficult to detect abnormalities using screening mammograms. In addition to the dense breast tissue, a physician will order a breast MRI exam for other reasons, such as: The difference between a breast MRI and screening or diagnostic mammography procedures is that the MRI exam requires the use of contrast. The intravenously injected contrast medium helps the abnormalities stand out on the MRI images. Report one of the following codes for a breast MRI examination: Review the provider’s documentation for laterality, as that is the basis for each of the codes listed above. Use 77046 or 77048 when the radiologist performs the procedure on only one of the patient’s breasts. Assign 77047 or 77049 when the breast MRI is performed on both of the patient’s breasts. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
