Radiology Coding Alert

Question: Recently a patient who had a breast removed was in for a mammogram. How should I assign the proper diagnosis and mammography code?

Florida Subscriber
Answer: Coding will depend on the attending physician's order. If the patient is free from symptoms, the mammogram is considered a screening study (76092, screening mammography, bilateral [two-view film study of each breast]). According to the Medicare Carriers Manual (4601.2A), V76.12 (other screening mammogram) is used to report all screening mammograms. In addition, the radiology practice may report V10.3 (personal history of breast cancer) and V45.71 (acquired absence of breast). Modifier -52 (reduced services) must be appended to 76092 because images of only one breast were obtained.
 
Of course, if the mammogram is ordered as a diagnostic study because the patient has related symptoms (e.g., 611.72, lump or mass in breast), it would be reported as a diagnostic service (76090, mammography; unilateral). Coders may also list V10.3 in the secondary diagnosis position.
Reader Questions and You Be the Coder were reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists.