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high risk unilateral screening mammograms

  1. #1
    Default high risk unilateral screening mammograms
    Medical Coding Books
    What procedure code are you guys coding for unilateral high risk screening mammograms on patients with history of breast cancer and mastectomy? The bilateral screening mammography code 77057 with a 52 modifier? Any help is much appreciated.

  2. #2
    Yes, any time you do a unilateral screening mammogram use the 52 modifier being the CPT codes state bilateral

  3. #3
    Duluth, Minnesota
    seems to me, if you do a "unilateral" mammography, you'd use the "unilateral" mammography code - since there is one... 77058 - I'd be using the history of breast cancer dx code secondary to the sceening mammo code. I wouldn't be using a bilateral code with 52 mod on it because they're only doing it unilaterally - when there is a specific unilateral code for the procedure.

    anybody else? I way off on my thinking?
    Donna, CPC, CPC-H

  4. Default
    77058 is a MRI screening, a regular routine screening is 77057, and the other 77056 is diagnostic. (bilateral) If a Dr. states "screening" mammogram it is to be coded 77057 and a 52 modifier, 1 sided. Depending on your provider which ICD code, but I use v76.12, v10.3 and v45.71 with that type of procedure you described.
    I went back and researched my notes, and this is from CSI 2006 edition, but it states: v76.11 is for high-risk patient who has had a personal hx of breast cancer, has a mother or sister or daughter with breast ca, not given birth prior to the age of 30, personal hx of biopsy proven benign breast disease

    CMS no longer has separate coverage criteria for high-risk patients, however, the above list is useful in determining whether to assign code v76.11 .

    If abnormality is found on the screening mammogram, a secondary diagnosis code can be assigned to describe the findings, but a code from V76 should still be submitted as the first listed code.

    Diagnostic mammograms should be reported according to the official guidelines for coding diagnostic tests. Code v76.11- v76.12 are not to be used for diagnostic mammograms.

    ***this was type directly from the CSI information on coding breast mammograms.
    Last edited by pharmon; 10-29-2008 at 10:45 AM.

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