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Diagnostic Mammo

K

KoBee

Expert
Messages
455
Hello everyone -

If a patient in 2023 has been just following up every 3-6 months on a mass on her breast by just doing a limited ultrasound to just keep an eye on it and then comes in 2024 for one year surveillance exam, would the diagnosis still be Z12.31?
 
Make sure the provider is following the ACR appropriateness criteria.
https://acsearch.acr.org/list
https://acsearch.acr.org/docs/69495/Narrative/

If indeed the criteria states a mammogram is indicated, it would not be a screening mammogram; it would be a diagnostic mammogram. Therefore, you would not code Z12.31. You would code the breast mass.

Again, they need to go by the ACR approriateness criteria.
 
xXxPARAGONxXx said:
Make sure the provider is following the ACR appropriateness criteria.
https://acsearch.acr.org/list
https://acsearch.acr.org/docs/69495/Narrative/

If indeed the criteria states a mammogram is indicated, it would not be a screening mammogram; it would be a diagnostic mammogram. Therefore, you would not code Z12.31. You would code the breast mass.

Again, they need to go by the ACR approriateness criteria.
Click to expand...
Even if they are entititle for an annual screening? by coding the mass wouldnt that not be covered by payer?
 
KoBee said:
Even if they are entititle for an annual screening? by coding the mass wouldnt that not be covered by payer?
Click to expand...
It's no longer screening when there's a mass. Even if a patient were to self-refer and show up for a screening mammogram (per patient request), unless the patient is deceptive, the patient is going to provide the facility with info that she has a mass, and that screening mammogram is going to be converted to a diagnostic mammogram.

What was patient's BI-RADS categorization? If she is BI-RADS 3, then I believe the protocol is 6, 12, and 24 months diagnostic imaging, after which time, if the mass has remained stable, they can resume screening imaging.

https://radiopaedia.org/articles/br...-system-bi-rads-assessment-category-3?lang=us
https://www.michigan.gov/mdhhs/-/me...c018fcf&hash=B3422E7F6B2F0584D7C3C1D3977655D3
 
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