Radiology Coding Alert

Question: We had a patient come to our imaging center because a previously identified lump in her breast appeared to be enlarged. The treating physician ordered a new mammogram and asked that our radiologist also read the mammogram taken a year ago at another facility. Because our radiologist is conducting a comparison reading, can we bill for that interpretation as well as the interpretation of the new mammogram?

Tennessee Subscriber

Answer: No, you should not bill anything other than 76090 (mammography; unilateral) if one breast was studied or 76091 (mammography; bilateral) if both were evaluated. Comparing a current study with previous films is considered part of the mammogram service, regardless of whether they were taken at the same or different facilities.

This is true not only for mammography but for other imaging services like skeletal x-rays as well.

At times, these comparison studies are confused with a second opinion or second interpretation. If the physician has requested a second opinion on a previously evaluated study, 76140 (consultation on x-ray examination made elsewhere, written report) may be assigned. Some payers, however, will not reimburse for these consultations, and patients must be made aware that they may be billed for the service.