#Icd 10 cad code#
When a screening and diagnostic mammogram is performed on the same patient on the same day, modifier-GG should be appended to the appropriate CPT/HCPCS code.įor those rare occasions when performing a unilateral screening mammogram, since CPT Code 77057 is inherently bilateral, bill CPT Code 77057 (and CPT 77051, if appropriate) with a modifier 52, reduced service, along with an explanation in Item 19 on the CMS 1500 claim form or the electronic equivalent. GH modifier denotes that diagnostic mammography converted from screening mammogram on the same day. Modifiers For Screening & Diagnostic Mammographyįor screening mammography that turns into diagnostic mammography report codes CPT 77055 or CPT 77056 with GH modifier. Payment can be made for another screening mammography in January 2013.
Smith received a screening mammography examination in January 2012, begin counting the next month (February 2012) until 11 months have elapsed. To determine the 11-month period, intermediaries and carriers start counting beginning with the month after the month in which a previous screening mammography was performed.įor example: If Mrs.
#Icd 10 cad full#
Over age 39: For a woman over 39, pay for a screening mammography performed after 11 full months have passed following the month in which the last screening mammography was performed. Pay for only one screening mammography performed on a woman between her 35th and 40th birthday. Less than 35 years old: No payment may be made for a screening mammography performed on a woman under 35 years of age.ģ5-39 years old: (Baseline). ICD 10 CM Z12.31: Encounter for screening mammogram for malignant neoplasm of breast. ICD 10 CM Z80.3: Family history of malignant neoplasm of breast. ICD 10 CM Z85.3: Personal history of malignant neoplasm of breast. Diagnostic Mammogram CPT Code 77065 & CPT 77066ĬPT 77065 Description: Diagnostic mammography, including computer-aided detection (CAD) when performed unilateral.ĬPT 77066 Description: Diagnostic mammography, including computer-aided detection (CAD) when performed bilateral.
Screening Mammogram CPT Code 77067ĬPT 77067 Description: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. Underneath the descriptions of the CPT codes for screening & Diagnostic Mammogram. Section 4101 of the Balanced Budget Act (BBA) of 1997 provides for annual screening mammographies for women over 39 and waives the Part B deductible, however, coinsurance is applicable. Payment may be made for a screening mammography furnished to a woman at her direct request, and based on a woman’s age and statutory frequency parameter. Unlike diagnostic mammographies, there do not need to be signs, symptoms, or history of breast disease in order for the exam to be covered.Ī doctor’s prescription or referral is not necessary for the procedure to be covered. The term “screening mammography” means a radiologic procedure provided to an asymptomatic woman for the purpose of early detection of breast cancer and includes a physician’s interpretation of the results of the procedure.
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