Billing and Coding: CPT 2017 Updates Mammography Codes, but CMS Does Not
By Barbara Aubry, RN, CPC, CPMA, CHCQM, FABQAURP, and John Verhovshek, MA, CPC
Vol. 18 No. 5 P. 6
For the past several years, proper coding for mammography services has depended on which payer the claim was filed with. The American Medical Association CPT codebook contained codes 77051 through 77057, which were accepted by most commercial payers. The Centers for Medicare & Medicaid Services (CMS), by contrast, required the use of dedicated G codes, created specifically for claims to Medicare payers. Unlike CPT codes 77051 through 77057, CMS G codes included computer-aided detection (CAD), when performed.
New Codes, Same Problem (for Now)
For 2017, CPT deleted codes 77051 through 77057 and introduced three new codes whose descriptors not only include CAD when performed but also exactly match those of the G codes required when reporting mammography to Medicare payers.
• 77065, Diagnostic mammography, including CAD when performed; unilateral.
• 77066, Diagnostic mammography, including CAD when performed; bilateral.
• 77067, Screening mammography, bilateral (two-view study of each breast), including CAD when performed.
In a perfect world, the new CPT codes would result in uniform coding of mammography services. But, due to technical issues, CMS was unable to ready its systems to process claims using CPT codes 77065, 77066, and 77067. As a result, mammography claims to Medicare in 2017 must continue to use G0202, G0204, and G0206.
Specifically, according to cms.org, CMS instructs that mammography be described using the following codes:
• G0202, Screening mammography, bilateral (two-view study of each breast), including CAD when performed.
• G0204, Diagnostic mammography, including CAD when performed; bilateral.
• G0206, Diagnostic mammography, including CAD when performed; unilateral.
Breast tomosynthesis is described using the following add-on codes:
• 77063, Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure).
• G0279, Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to G0204 or G0206).
When breast tomosynthesis is provided, practitioners should report one of G0202, G0204, or G0206 and one of G0279 or 77063. For purposes of billing digital breast tomosynthesis, the appropriate, accompanying 2D image(s) may either be acquired or synthesized.
The Bottom Line
In 2017, you'll continue to report mammography services for Medicare patients in the same way you reported them in 2015 and 2016. Use the G codes regardless of whether CAD was performed during mammography.
Note: CMS says it does intend to recognize the CPT codes 77065, 77066, and 77067—in place of the G codes—in 2018.
When reporting mammography services to non-Medicare payers who follow CPT guidelines, you should report new codes 77065–77067, which include CAD when performed.
To illustrate, consider the following examples:
• A Medicare patient undergoes a screening mammogram without tomosynthesis. Report G0202.
• A Medicare patient undergoes a screening mammogram and screening tomosynthesis. Report G0202 and 77063.
• A Medicare patient undergoes a diagnostic mammogram. Report either G0204 (bilateral) or G0206 (unilateral). If tomosynthesis is also ordered, report G0279 in addition to either G0204 or G0206, as appropriate.
• A patient with commercial insurance undergoes a screening mammogram. This payer follows CPT guidelines. Report 77067. If screening tomosynthesis is ordered and performed, also report 77063.
• A patient with commercial insurance undergoes a screening mammogram and screening tomosynthesis. This payer follows CPT guidelines. Report 77067 and 77063.
• A patient with commercial insurance undergoes a diagnostic mammogram. This payer follows CPT guidelines. Report either 77065 (unilateral) or 77066 (bilateral), depending on the order. If diagnostic tomosynthesis is provided, also, add G0279.
— Barbara Aubry, RN, CPC, CPMA, CHCQM, FABQAURP, is a senior regulatory analyst for 3M Health Information Systems.
— John Verhovshek, MA, CPC, is managing editor for AAPC.