Wiki Unilateral screening mammogram

[elizabethmullinix@gmail.com]

Hello, colleagues!
What is the appropriate way to code for a unilateral screening mammogram (post-mastectomy). I am aware that the provider can perform diagnostic mammograms for patients with history of breast cancer, but at this stage in the patient's remission the provider deems it is more clinically appropriate to do a screening. The 77067 screening mammogram code is bilateral by definition, and there does not exist a unilateral screening code. Is there any official position from CMS as to whether this can still be billed with the standard bilateral screening mammogram code? It seems another school of thought is to bill with the 52 reduced modifier? Our provider is looking for any published information on the subject.
Many thanks!

 

[trarut]

Check your payer guidelines. Since the only screening code is bilateral, they should provide guidance on how a unilateral screening mammo should be reported to the plan. I found the following guidance on the American College of Radiology website, which advises the same thing.

https://www.acr.org/Advocacy-and-Economics/Coding-Source/March-April-2019/Breast-Imaging-FAQ

How do you code for a unilateral screening mammogram in a patient who has had one of her breasts removed? The code descriptor for a screening mammogram specifies that it is a bilateral study.​

When a screening mammography study is ordered and performed on a patient who has only one breast, it is appropriate to report 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. Because the CPT code descriptor for 77067 states “bilateral,” it would be appropriate to use a 52 modifier (reduced level of service) to designate a screening procedure of only one breast. However, radiology practices should check with their local carrier and other third-party payers regarding the use of the 52 modifier in this situation, because some payers have stated that a 52 modifier is not necessary for reporting a unilateral screening mammogram.