Wiki mammogram and abus

[winkleramy]

Hi everyone,
I am new to the ob side of coding and the new place that I am working at does mammograms and automated breast ultrasound (abus). I am trying to find the policy on the medicare website to see what dx codes are allowed for these procedures. I also need to find the policy for dexa scans. Any help is greatly appreciated.

 

[nielynco]

Hi everyone,
I am new to the ob side of coding and the new place that I am working at does mammograms and automated breast ultrasound (abus). I am trying to find the policy on the medicare website to see what dx codes are allowed for these procedures. I also need to find the policy for dexa scans. Any help is greatly appreciated.

Medicare coverage for breast exams can be found at: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52849&Cntrctr=275. But keep in mind that many payers have a written policy that states the ABUS is investigational so be sure patient is aware and it would be a good idea to get this exam prior authorized so the patient is not faced with an unexpected out-of-pocket expense. Medicare says they may cover it is it is "medically indicated" and I think that means you have to prove it before they will pay.

For DEXA coding and coverage go to: https://www.cms.gov/Regulations-and...ls/Internet-Only-Manuals-IOMs-Items/CMS012673 and scroll down to Chapter 15, Section 80.5 (click on it to get coverage information). For billing Medicare go to the Medicare Claims Processing Manual, Chapter 13, Section 140 (https://www.cms.gov/Regulations-and...ls/Internet-Only-Manuals-IOMs-Items/CMS018912)