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Diagnostic Mammogram for Screening Purposes after Elective Breast Augmentation

  1. #1
    Default Diagnostic Mammogram for Screening Purposes after Elective Breast Augmentation
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    I am looking for any advice on the ICD 9 coding for a patient who is having a diagnostic mammogram for screening purposes after elective breast augmentation. The patient has no reason for the diagnostic mamm other than the presence of the implants. From the research I have done, there is no inherit higher risk to the implants warranting the diagnostic mamm, just more views to be obtained, so am I don't feel V76.11 is appropriate or V43.82.
    Any help is greatly appreciated.

  2. #2
    Albany, Oregon
    Default Post elective breast augmentation
    If you haven't already looked at these, you might try one of these V-codes:
    They're in no particular order.
    Good luck,
    Pat Kidd, CPC, CGSC

  3. #3
    Columbia, MO
    It is screening it is not diagnostic. Use the screening V code.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    How about the reason for breast augmentation, e.g. pain, etc. with v45.89 (other post surgical status) as second.

  5. #5
    Columbia, MO
    if the breat augmentation has been done then the reason to hav it done should no longer exist so do not code it. You can use the post procedural status but why? If this is a routine screening then it is screening no atter what. she is either screening high risk or not not. Her post procedural status does not enter into the screening part. If this is a mamm that is not for routine screening.. then the question becomes what is the reason for a diagnostic mamm. If the patient has no screening benefits then the patient will be liable for the bill. There is no other way to do this. If you are ordering a diagnostic mamm then you must have medical necessity or it will not be paid. Without the documentation it is difficult to advise on the code for your scenario, but I am guessing this has to do with a routine breast cancer screening that the patient is wanting her carrier to pay for as a high risk diagnostic procedure. So I go back to if it is for screeing then use screening. If it is diagnostic then what did the physician document as the medical necessity for the test.

    Debra A. Mitchell, MSPH, CPC-H

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