Unilateral screening mammogram with history of mastectomy

[angeleyzs86]

I'm just trying to get a definite answer on what diagnosis code would you use for a patient that comes in for a unilateral screening mammogram with a history of a left mastectomy? No where does it state on the report about breast cancer. Should this be coded at V76.12 or V76.11? Or is there another diagnosis that should be used. Thanks!

 

[jgf-CPC]

mammo

She would be considered high risk so it would be V76.11 but you can also add a secondary code if something is found on that screening. Hope that helps.

 

[screed@urhcs.org]

What are you using for the procedure code? The 77057 is for a bilateral mammogram.

 

[angeleyzs86]

Yes, I'm using 77057 with a 52 modifer.

 

[LScottCPC]

You can code the V45.71 to indicate the mastectomy. Also check with the insurance carrier concerning the mod -52. Preferred Care/MVP in NY doesn't like the use of that modifier even if there has been a mastectomy. I believe that this is also true for Medicare in NYS. Just a thought!

 

[angeleyzs86]

Dx for the screening

I understand that I could use the V45.71 as an add on code, but I'm still unsure what screening code to use (V76.10-V76.19). The screening is the reason for the exam, but does the fact that she had a mastectomy (without any documention of present or history breast cancer) make her high-risK? For all we know, she was in a horrible accident and had to have the one breast removed.

 

[LScottCPC]

Does it state any other risk factors such as family with breast cancer, never having children, prior bx? Any of those things will indicate the high risk V76.11. If none of those things are stated and you don't feel comfortable using the high risk code, you could either ask for more information or use the V76.12. Hope that this helps!