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Mammography Coding Changes Highlighted During Breast Cancer Awareness Month

Posted by David Fong on Oct 17, 2019 7:00:00 AM


October is Breast Cancer Awareness Month.  As part of the overall push for mammogram screening and self-checks, there are also calls for practices to ensure they are coding properly for Medicare-provided mammograms. According to a recent AAPC blog post written by Barbara Aubry, RN, AAPC fellow, there are several important ICD-10-CM updates, recently deleted codes, and updates for 2020. These updates began on October 1st for FY 2020.


New changes outlined include:

  • The Centers for Medicare & Medicaid Services (CMS) now recognizes various CPT® mammogram codes, which simplifies the process for reporting of these types of services.
  • Older “G” codes used previously were set for retirement in 2018.


The post goes on to detail the CPT codes for use in the new FY 2020:

  • 77063 for screening digital breast tomosynthesis, bilateral, 77065 for diagnostic mammography, including instances using computer-aided detection (CAD) and it’s unilateral, 77066 for bilateral, and 77067 for screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD)


There are also changes to FY 2020 codes for diagnostic mammography, including N63.15 for an unspecified lump in the right breast, with overlapping quadrants, and code N63.25 for an unspecified lump in the left breast. The blog post details that while these codes apply to diagnostic mammograms, it further encourages readers to regularly check the CMS’ National Coverage Determination (NCD) for Mammograms (220.4) before coding to ensure they catch all of the latest announcements and related adjustments. 


An important note raised in the blog pertains to coders sometimes mistakenly adding modifiers that designative the LT “left side” or RT “right side”. However, these are not needed as the CMS-approved codes account for both unilateral and bilateral service types.


The deletion of some outdated codes and the recent acceptance of CPT mammogram codes is intended to streamline the entire process for all involved. Keeping track of these changes and coding correctly is a persistent challenge for mammography providers.


The team of experienced and accurate coders at Aviacode understand the latest changes and modifiers and how to properly use them for every clinical situation. We have expert certified coders with experience with women’s health and more than 60 other medical specialties. The importance of using experienced outsourced coders can make the difference in coding correctly or missing out on the latest ICD-10-CM changes, which can cause denials or missed reimbursements.


Topics: ICD-10, Medical Coding, Pro-Fee Coding