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Mammogram coding - Need clarification

  1. Default Mammogram coding - Need clarification
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    Need clarification please.

    Sept. 2010 patient has annual mammogram with findings of breast density and follow up in 6 months. We coded V76.12 and 611.79.

    Nov. 2010 patient has repeat 6 month followup with breast density and followup in 6 months again. We coded 611.79 and V76.11

    May 2011 patient has 6 month followup again still with breast density and request for followup in 6 months again. We coded 611.79 and V76.11

    Does this look appropriate or are we missing something. The insurance is telling the patient they won't pay for the May 2011 visit because we coded it incorrectly.

    Thanks in advance for any help.

    Shawna

  2. #2
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    Are you billing for diagnostic mammo?

  3. #3
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    Are you doing ultrasounds in between or all diagnostic mammos with the 793.8- codes? This shows there was an abnormal mammo.

  4. Default
    May 2011 patient has 6 month followup again still with breast density and request for followup in 6 months again. We coded 611.79 and V76.11

    Breast density is coded to 793.82 and I don't believe the V76.11 should be included. (At least in the follow-ups, but I may be wrong)

    I noticed that the first mammo you coded V76.12 and the following ones as V76.11 (High risk patient)

  5. Default
    Mammogram started as diagnostic.

  6. #6
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    I agree with Julesofcolorado. The diagnositic study should have been coded with 793.82 to show that the exams were abnormal and their is good reason for repeating the exams
    Catrina Jacobs, RCC, CPC

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