Although additional views may be needed, these additional views do not necessarily constitute a diagnostic mammogram, unless there are specific findings that require investigation. These diagnoses should not, however, routinely warrant a diagnostic mammography.Ī breast implant does not necessarily imply that a mammogram is diagnostic in nature. follow-up of established history of a malignancy is necessaryĭiagnostic breast evaluation may be indicated in cases of a personal history of malignancy and in cases of benign biopsy-proven breast disease. there is short interval follow-up (less than one year) necessary for unresolved clinical/radiographic concerns or there are possible radiographic abnormalities detected on screening mammography
#Icd 10 code for cad skin#
there are signs and/or symptoms suggestive of malignancy (mass, some types of spontaneous nipple discharge or skin changes) the patient is under the care of the referring/ordering physician or qualified non-physician practitioner Services will only be allowed if supplied by certified suppliers or FDA-certified mammography centers.Ī diagnostic mammography is a radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, or a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease, and includes a physician’s interpretation of the results of the procedure.ĭiagnostic mammogram(s) are allowed for the following indications: Women with breast implants are eligible for screening mammography when the screening mammogram is performed within the aforementioned age and frequency limitations. Women between the ages of 35 and 39 are eligible to receive one baseline screening mammogram. Screening mammogram(s) (digital and non-digital) for the following indications are allowed:Īsymptomatic women ages 40 and older are eligible for a screening mammography (digital and non-digital) performed after at least 11 months have passed following the month in which the last screening mammography was performed. The cost for additional views is included in the cost of the diagnostic mammography service. No separate reimbursement will be made for additional views. Radiologists who order additional tests must refer back to the treating physician or qualified non-physician practitioner for his/her UPIN and report back to the treating physician the condition of the patient. When this is the case, the mammography is no longer considered to be a screening exam and should be reported as a diagnostic mammogram. A screening mammogram does not require a physician’s referral, however, detection of a radiographic abnormality, may prompt the interpreting radiologist to order additional views on the same day.
Use modifier –GG to show a screening mammogram turned into a diagnostic mammogram.Ĭoverage Indications, Limitations, and/or Medical NecessityĪ screening mammography is a radiologic procedure furnished to a woman without signs or symptoms of breast disease, for the purpose of early detection breast cancer,and includes a physician’s interpretation of the results of the procedure. G0202 – Screening mammography, producing direct 2-D digital image, bilateral, all views NOTE: If billing a screening mammogram and a diagnostic mammogram on the same day, Update: Medicare now requires an add-on code when you furnish a mammography using 3-D mammography in conjunction with a 2-D digital mammography, effective January 1, 2015.ħ7052 – Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation screening mammography (List separately in addition to code for primary procedure)ħ7057 – Screening mammography, bilateral (2-view film study of each breast)ħ7063 – Screening digital breast tomosynthesis bilateral (List separately in addition to code for primary procedure) (Use this as an add-on code to G0202 when tomosynthesis is used in addition to 2-D mammography) – average fee payment – $50 – $60
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