If the patient presents for a screening mammogram and one is performed, it is coded as screening.
Diagnostic mammograms are those done for any abnormality or perhaps patient symptom or history. Diagnostic mammograms are usually those ordered after a screening has been performed--even if that screening had an abnormal impression.
So, to make a long story short, from a CPT standpoint, both should be coded as they were ordered (screening versus diagnostic). For ICD I would code the primary reason for the order and/or any impression stated by the reading Radiologist, following the stated guidelines of ICD on that matter.
Hope this helps.
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