October is Breast Cancer Awareness Month. Make sure your practice’s medical coding for preventive screening mammograms is up to date with current guidelines.

Coding Mammograms for Medicare

The Centers for Medicare & Medicaid Services (CMS) has caught up to the industry and now recognizes the CPT® mammogram codes. This makes it easier for coders to accurately report mammogram services. The G codes CMS used in the past (G0202, G0204, and G0206) were deleted on Jan. 1, 2018.

For reporting mammograms in 2019, use these CPT® codes:

+77063   Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)

77065     Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

77066                  bilateral

77067     Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

Also report G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066), when appropriate.

Appending Modifiers for Laterality

Often coders feel obliged to add either modifier 50 Bilateral procedure or LT Left side, RT Right side, or both believing that these modifiers help define the service. Neither modifier is required with the mammography codes, however, because the codes represent both unilateral and bilateral services.

CGS Medicare — Medicare Administrative Contractor for Jurisdiction 15 Part B — explains:

HCPCS code G0279 has been assigned a bilateral indicator “2” in the Medicare Physician Fee Schedule Database (MPFSDB). A “2” indicator means special payment adjustment for bilateral does not apply. Because of this, bilateral modifiers (e.g., CPT modifier 50, HCPCS modifiers RT/LT) are not to be included and the units field should indicate a quantity of “1.”

Coding Mammography in 2020

Report mammography services using the appropriate CPT® codes and G0279, when ordered on the date of service. Be sure the service ordered and performed matches the description of the code. It’s easy to confuse screening versus diagnostic and the accompanying tomosynthesis codes.

There are some ICD-10-CM code changes for 2020. New diagnosis codes effective Oct. 1, 2019, include:

N63.15   Unspecified lump in the right breast, overlapping quadrants

N63.25   Unspecified lump in the left breast, overlapping quadrants

Although these codes apply to diagnostic mammograms, be sure to review CMS’ National Coverage Determination (NCD) for Mammograms (220.4) prior to coding. CMS has made multiple changes to the NCD 220.4, since its inception. It is important to monitor CMS publications for NCD changes to be able to access the latest version that often includes important coding updates. Your Medicare administrative contractor’s website is a good location for update announcements.

Coding Example

A 67-year-old Medicare patient came in today for her yearly mammogram. She has a history of dense breast tissue bilaterally. Because of this, she undergoes a diagnostic rather than a screening mammogram yearly. Report procedure code 77066, plus G0279 for the tomosynthesis if it was ordered. Remind providers to use G0279 when ordering a tomosynthesis for Medicare patients for either screening or diagnostic mammograms.

Breast Health: Ask a Physician What’s Best

Understanding a physician’s point of view when coding their services is a good idea. Read the interview “Get a Physician’s Perspective on Breast Health and Coding” to receive clinical and medical coding guidance from breast surgeon Sasa-Grae Espino, MD (written by Cynthia Briggs, CPC, CPMA, CCVTC). You can find it in the October 2018 edition of Healthcare Business Monthly (pages 40-43) and on AAPC’s Knowledge Center.

Resources

CGS. “Add-On HCPCS Code G0279 for Diagnostic Digital Breast Tomosynthesis.” May 11, 2015.

CMS. National Coverage Determination (NCD) for Mammograms (220.4).