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mammo coding

  1. #1
    Default mammo coding
    Medical Coding Books
    When coding for a bilat mammo for a patient with implants we use the 77056/V43.82. Our billing department is saying these are being denied. Is this the correct codes to be using?..
    Also, if there is something found on the orig mammo and the patient has to come back for add views of both breasts can we charge 77055-Lt and 77055-Rt since there is more involved in taking of the xrays and more films used than just the 77056? Thanks

  2. #2
    Default
    I'm not sure how to answer your first question with ICD-9 code you are using but as for the second, it's not appropriate to bill RT and LT for 77055- you must use 77056


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Default
    I found this on supercoder- Don't use the presence of implants alone as a justification for the diagnostic mammography code, especially for a Medicare patient, Hardy advises coders. According to CMS, patients with breast implants do not automatically qualify for diagnostic mammograms.

    That means the same breast cancer screening guidelines that apply to women who don't have implants, apply to those who do.

    Hope this helps!


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by TLC View Post
    When coding for a bilat mammo for a patient with implants we use the 77056/V43.82. Our billing department is saying these are being denied. Is this the correct codes to be using?..
    Also, if there is something found on the orig mammo and the patient has to come back for add views of both breasts can we charge 77055-Lt and 77055-Rt since there is more involved in taking of the xrays and more films used than just the 77056? Thanks
    I would think you need the appropriate V76.xx code first and teh V43.82 second.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    Quote Originally Posted by ajs View Post
    I would think you need the appropriate V76.xx code first and teh V43.82 second.
    .... V76.xx is only for screening.

    Our office is a radiology grp all our mams are DIGITAL so we use G0202 for screening mam w. 77052 for the CAD dx V76.1_. For call back its G0204 for bilateral or G0206 for unilateral and if a CAD is done 77051 w/ what ever dx. We don't change the cpt whether or not the pt has implants just the dx.
    for dx on call backs depending on the reason chck these code grps 793.8_ and 611.7_


    hope this helps
    Last edited by TamaraM; 01-06-2012 at 11:38 AM.

  6. #6
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by TLC View Post
    When coding for a bilat mammo for a patient with implants we use the 77056/V43.82. Our billing department is saying these are being denied. Is this the correct codes to be using?..
    Also, if there is something found on the orig mammo and the patient has to come back for add views of both breasts can we charge 77055-Lt and 77055-Rt since there is more involved in taking of the xrays and more films used than just the 77056? Thanks
    If a diagnostic mammogram is being ordered solely because the patient has implants and no clinical indication of breast cancer, then your coding is correct and you should expect a denial. If a screening mammogram was ordered and you changed it to diagnostic based on the patient having implants, then you should not, you should code it as a screening and use dx codes V76.12 and V43.82.

    And no, you can't code 77055 twice instead of 77056. 77056 includes as many films as is necessary, whether that is 2 or 200.

  7. Default Diagnostic mammo
    Will Medicare cover diagnostic mammo only w/dx of history of abnormal mammograms in the past? (Instead of having pt go for mammo and return for diagnostic, just going straight to diagnostic mammo)

  8. Default
    Quote Originally Posted by Maureen View Post
    Will Medicare cover diagnostic mammo only w/dx of history of abnormal mammograms in the past? (Instead of having pt go for mammo and return for diagnostic, just going straight to diagnostic mammo)
    In my expeirence yes. I'm assuming that this is a dx mam not a yearly screening. For a dx mam that is being done due to an abnormal mam in the past you would use 793.8_ (793.80 is abnormal mam, unsp.) my offices uses this code grp quite a bit on mam, and I don't believe we have any problems with MCR paying on them

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