Mammography Coding Update
Issue: #396 SEP2017
Providers should submit claims for mammography services based on the care that is provided. There are numerous scenarios for breast screening and follow-up based on technology used and diagnoses. To alleviate confusion, Blue Cross Blue Shield of North Dakota (BCBSND) proposes the following billing examples when digital breast tomosynthesis is used as part of a screening or diagnostic work-up.
Bilateral Screening Mammography with Screening Digital Breast Tomosynthesis
- CPT 77057 – Screening mammography, bilateral (two-view film study of each breast) (Code deleted Jan. 1, 2017)
- CPT 77067 – Screening mammography, bilateral (two-view study of each breast), including computer-aided detection (CAD) when performed
- 77063 – Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)
Diagnostic Mammography with Diagnostic Digital Breast Tomosynthesis
- HCPCS G0204 – Diagnostic mammography, producing direct 2-D digital image, bilateral, all views; or
- HCPCS G0206 – Diagnostic mammography, producing direct 2-D digital image, unilateral, all views; and
- G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206)
In both scenarios, the appropriate ICD-10 diagnosis code should be used to reflect whether this was a screening or performed for a diagnostic mammogram.