Mammography coding is the topic of this “Spotlight on CPT”. Mammography is a radiological procedure performed on the breast(s) for either screening or diagnostic purposes. Screening mammograms are done to detect breast cancer in the absence of symptoms, while diagnostic mammograms are done to evaluate abnormalities that have been detected in the breast.
Screening mammograms are assigned to CPT code 77067. This code is inclusive of any computer-aided detection (CAD) that may be used and is a 2-view study of both breasts.
There are two codes for diagnostic mammography assignment, either 77065 for a procedure performed unilaterally, or 77066 for a bilateral procedure. Again, similar to the screening code, if CAD is performed it is included in the same code.
Breast tomosynthesis is referred to as 3D mammography. It provides multiple views of the breast from a variety of angles and is particularly helpful in the evaluation of patients with dense breasts. Like regular mammography codes, the CPT codes for tomosynthesis are subdivided between screening and diagnostic. The screening code is an add-on code of 77063 and should be assigned in addition to the primary procedure. Again, like the screening mammography code, this is bilateral. The diagnostic tomosynthesis codes are unilateral (77061) or bilateral (77062). These diagnostic codes are not add-on codes, but stand-alone and would not be reported with the screening mammogram code (77067).
A CPT Assistant from February 2016 addressed which type of mammogram should be coded for a woman who has breast implants and is not experiencing any symptoms. The advice given is that the mammogram should be considered a screening.
An important point to remember about the mammography codes is that they can be assigned for both males and females (CPT Assistant, June 1999). The focus is on the type of mammography, screening or diagnostic, not the sex of the patient receiving the test.
Now, light has been shed on coding mammography.
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
