Every woman is at risk for developing breast cancer, and the risk increases with age. According to the Centers for Disease Control and Prevention (CDC), approximately 94 percent of breast cancers are diagnosed in women over 40. Mammography is the best available way to detect breast cancer early, when it is most curable. A mammography is a low-dose X-ray of the breast that can find lumps too small to be felt during a breast examination. The breast is compressed firmly between two planes and pictures are taken.
A screening mammogram is used to detect breast changes in women who have no signs of breast cancer. When the patient has signs or symptoms of a suspected disease, a diagnostic mammography is performed instead.
It is essential coders understand the ICD-9-CM diagnosis, CPT and HCPCS coding guidelines for accurate code assignment for mammography.
The diagnoses codes used to report encounters for a screening mammography are:
• V76.11, Special screening for malignant neoplasm, screening mammogram for high-risk patients
• V76.12, Special screening for malignant neoplasm, other screening mammogram
The following codes may be assigned along with code V76.11 to identify why the patient is considered to be at high-risk.
• V10.3, Personal history of malignant neoplasm, breast
• V16.3, Family history of malignant neoplasm, breast
• V15.89, Other specified personal history presenting hazards to health, other
For Medicare patients, diagnosis codes V76.11 and V76.12 must be reported as the first listed diagnosis when a claim contains only screening mammography services. When billing a screening mammogram with other services billed on the same claim, codes V76.11 or V76.12 may be listed as a secondary diagnosis.
If a condition is found during the screening, the code for the condition may be used as an additional diagnosis. The rationale for this is even though a condition is found during the mammography, the visit is still considered a screening.
A screening mammogram is inherently bilateral and is reported with the following procedure codes:
• 77057, Screening mammography, bilateral (two view film study of each breast)
• G0202, Screening mammography, producing direct digital image, bilateral, all views
Code 77052, Computer aided detection, screening mammography, may be assigned when it is performed in addition to the primary procedure. Computer aided detection (CAD) indicates a laser beam was used to scan the mammography film and the image was then converted to digital data for computer analysis.
As mentioned earlier, if a condition is discovered during the screening, the code for the condition may be used as an additional diagnosis. In this instance, if the radiologist orders additional films based on the condition discovered during the screening mammogram, both procedures may be coded. When this occurs, append modifier GG, Performance and payment of a screening mammography and diagnostic mammography on same patient, same day to the diagnostic mammography code. Modifier GG indicates the test changed from a screening test to a diagnostic test. If not performed on both breasts, it is also important to append the appropriate anatomic modifier, RT or LT, to indicate on which side the diagnostic mammogram was performed.
A diagnostic mammography is performed when the patient has a complaint, such as a lump, or to investigate an abnormality found during a screening mammogram. For diagnostic mammograms, report the confirmed or definitive diagnosis that is documented in the medical record. It is not necessary to code related signs or symptoms in addition to the confirmed diagnosis. If the final interpretation is not available when the case is coded, or if there is no definitive diagnosis, report the signs or symptoms that prompted the mammography. Diagnoses typically assigned with a diagnostic mammography include but are not limited to:
• Lump or mass in breast (611.72)
• Pain in breast (611.71)
• Nipple discharge (611.79)
• Specified anomalies of breast (757.6)
• Neoplasms of breast, both male and female (174.0-175.9, 198.81, 217, 233.0, 238.3, 239.3)
The assignment of procedure codes is dependent on the services provided and the technologies used to perform the mammography. The following codes are used to report a diagnostic mammography:
• 77055, Mammography; unilateral
• 77056, Mammography; bilateral
• G0204, Diagnostic mammography, producing direct digital image, bilateral, all views
• G0206, Diagnostic mammography, producing direct digital image, unilateral, all views
Code assignment will be determined by whether or not direct digital images were taken and if the procedure was bilateral or unilateral. A diagnostic mammography without a direct digital image is coded to either 77055 or 77056, depending on the laterality of the procedure. A diagnostic mammography generating a direct digital image is coded to either G0204 or G0206, depending on the laterality of the procedure.
Add-on code 77051, Computer-aided detection, with further physician review for interpretation, with or without digitization of film images; diagnostic mammography, may be assigned in additional to codes 77055, 77056, G0204, or G0206 when performed in addition to the primary procedure. CAD uses computer software to review the mammography after the radiologist has interpreted it. If the software identifies any abnormalities, it marks them for further radiologist review.
Test your knowledge with the following quiz:
1. An asymptomatic 65-year-old woman had a screening mammogram, which revealed a breast mass. The physician scheduled the patient for follow-up biopsy of the breast mass at a later date. How should the diagnoses and procedures for this case be coded?
a. V76.12, 611.72, 77057
b. 611.72, 77057
c. V76.12, 77057
d. V76.11 611.72, 77056
2. An asymptomatic 70-year-old woman with a family history of breast cancer has a screening mammogram that reveals a right breast mass. As a result of the positive finding, a diagnostic mammogram of the right breast with direct digital image is then performed. How should the diagnoses and procedures for this case be coded?
a. V76.11, 611.72, G0206GGRT
b. 611.72, V76.11, V16.3, 77057, G0206GGRT
c. 611.72, V16.3, 77057, 77055GGRT, G0206
d. V7611, 611.72, V16.3, 77057, G0206GGRT
This month's column has been prepared by Cheryl D'Amato, RHIT, CCS, director of HIM, facility solutions, Ingenix, and Melinda Stegman, MBA, CCS, clinical technical editor, Ingenix (www.ingenix.com).
CPT is a registered trademark of the American Medical Association.
1. a. Assign diagnosis code V76.12 to indicate the screening for malignant neoplasm of breast and code 611.72, Lump or mass in breast, as an additional diagnosis to identify the breast mass. Procedure code 77057 is assigned to for the screening mammography.
2. d. Assign diagnosis code V76.11 to indicate that the breast cancer screening is being performed on a high risk patient. Secondary diagnosis codes V16.3, family history of breast cancer and 611.72, lump or mass in breast are also assigned. Procedure code 77057 is reported for the screening mammogram. Procedure code G0206 is assigned for the unilateral diagnostic mammogram producing direct digital image. Modifiers GG and RT are appended to code G0206 indicating that the screening mammogram was converted to a diagnostic mammogram of the right breast.