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Radiology Coding Alert

Reader Question:

Post-Mastectomy Ultrasound

Published on Mon Oct 01, 2001

Question: A patient with a history of breast cancer, which was treated with a mastectomy, presented with a lump on her chest wall. Our radiologist performed an ultrasound, but I am unsure if I should use the breast ultrasound code because the breast has been removed.

Oregon Subscriber  
Answer: Coding experts disagree about correct coding in this instance. Many recommend that the code for a breast ultrasound (76645, echography, breast[s] [unilateral or bilateral], B-scan and/or real time with image documentation) be reported. They point out that the clinical reason for the ultrasound may be scarring from the breast surgery, or recurrent or residual breast cancer in the chest wall. Therefore, the exam is indeed an ultrasound study of breast tissue (albeit cancerous and abnormal tissue).
 
Others recommend that the chest ultrasound code (76604, echography, chest, B-scan [includes mediastinum] and/or real time with image documentation) be reported since the chest wall is the structure being studied.
 
Coders should contact the payer in question and request written direction about which service to report.
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