CPT Code 77067 – Screening Mammography

The CPT code 77067 is for Screening Mammography, Bilateral (2-view study of each breast), including Computer-Aided Detection (CAD) when performed. This code is used when a medical provider conducts a routine screening mammogram by taking two X-ray views of each breast to detect any potential abnormalities. Additionally, the provider may utilize specialized computer software known as Computer-Aided Detection (CAD) to assist in identifying any suspicious areas on the mammogram images.

The CAD software converts signals into digital data and analyzes the images to help improve the accuracy of detecting abnormalities. This code reflects the comprehensive approach to screening mammography, incorporating both imaging technology and computer-aided analysis to enhance the detection of breast cancer.

Key guidelines for CPT code 77067 (Screening mammography) include:

1. A screening mammogram is performed on asymptomatic women to detect breast cancer early.
2. The procedure must involve a minimum of two views for each breast – cranio-caudal and medial lateral oblique views.
3. Medicare coverage: Medicare does not cover screening mammograms for women under 35. For women aged 35-39, Medicare will pay for one procedure. Women over 39 may receive reimbursement for a screening mammogram performed at least 11 months after the previous one.
4. Coding for unilateral screening mammogram in a patient with one breast removed: Use code 77067 with a 52 modifier to indicate a reduced service level for a unilateral screening mammogram; however, check with local carriers and payers as some may not require this modifier.
5. Additional magnification views: If additional views are needed for a suspected abnormality, both a screening and diagnostic mammogram can be reported. A GG modifier should be used if additional views are done on the same day as the screening mammogram.
6. NCCI edits: When screening and diagnostic mammograms are performed on the same patient on the same day, modifier GG should be used with the diagnostic mammogram code, and modifier 59 may be employed with the screening mammogram to bypass NCCI edits. Documentation of medical necessity for both exams is crucial to support the decision to bill for both services.
7. Billing for separate days: When a patient receives a screening mammogram on one day and returns for a diagnostic mammogram on another day, both services should be coded separately without the need for a GG modifier.

Understanding and adhering to these guidelines when using CPT Code 77067 is crucial for appropriate billing, coding, and reimbursement for screening mammography procedures.

What is the difference between CPT Code 77063 and CPT Code 77067?

CPT Code 77063 is used for screening digital breast tomosynthesis, which is a separate service provided in addition to the primary procedure. It is bilateral, meaning it involves both breasts.

CPT Code 77067, on the other hand, refers to screening mammography. This involves a 2-view study of each breast and includes computer-aided detection (CAD) when performed. Like 77063, 77067 is also a bilateral procedure.

The main difference between the two codes lies in the imaging techniques used: 77063 is for digital breast tomosynthesis, while 77067 is for traditional screening mammography. Both codes are essential for comprehensive breast cancer screening, with tomosynthesis providing a more detailed and layered view of breast tissue compared to traditional mammography.

Can CPT 77067 and 77063 be billed together?

CPT codes 77063 and 77067 can be billed together. Code 77063 is used for screening digital breast tomosynthesis, while 77067 is for screening mammography with computer-aided detection (CAD). It is appropriate to bill these two codes together as they complement each other, providing a comprehensive screening approach for breast health assessment. Use code 77063 in conjunction with 77067 to ensure accurate billing for both the tomosynthesis and mammography services rendered during the screening. This combination allows for a more detailed evaluation of breast tissue, enhancing the detection and diagnosis of potential abnormalities. Consequently, billing CPT codes 77063 and 77067 together is appropriate and reflects the thoroughness of the screening process.

How to code for unilateral screening mammogram in a patient with one breast removed?

When coding for a unilateral screening mammogram in a patient who has had one breast removed, you should utilize CPT code 77067, which is specified for screening mammography. Despite the code descriptor indicating a bilateral study, it is acceptable to use this code for a single-breast screening. However, to denote the reduced level of service for screening only one breast, you may consider appending a 52 modifier to the code. It is advisable to check with local carriers and third-party payers regarding the necessity of the 52 modifier, as some may not require it for reporting a unilateral screening mammogram. This modifier communicates that a service was partially reduced or eliminated based on clinical judgment, indicating that only one breast was screened in this particular case.

CPT Code 77066 vs CPT Code 77067?

CPT Code 77066 is used for diagnostic mammography, including computer-aided detection (CAD), when performed on both breasts. This code is specifically for cases where a diagnostic evaluation is necessary due to symptoms or findings that require further investigation.

On the other hand, CPT Code 77067 is used for screening mammography, which involves a bilateral 2-view study of each breast. This code is used for routine screening purposes in asymptomatic patients to detect any signs of breast cancer at an early stage.

In summary, the key difference between CPT Code 77066 and CPT Code 77067 lies in their purposes – 77066 is for diagnostic mammography, while 77067 is for screening mammography. Both codes may involve computer-aided detection (CAD) when performed, but the indication for the imaging study determines which code is appropriate to use.

Can we bill CPT Code 77065 or 77066 (Diagnostic mammogram) and CPT Code 77067 (Screening mammogram) together?

Billing for both a diagnostic mammogram (CPT Code 77065 or CPT Code 77066) and a screening mammogram (CPT Code 77067) on the same day is generally not permissible. The Centers for Medicare & Medicaid Services (CMS) and most insurance companies have strict guidelines regarding billing for multiple services on the same day, especially when one is considered preventive (screening) and the other is diagnostic.

If additional magnification views are required for a suspected abnormality found during a screening mammogram, both the screening and diagnostic mammogram services should be reported separately. The diagnostic mammogram should be billed with the relevant diagnostic code reflecting the reason for the exam (such as 77065 or 77066), along with modifier GG if performed on the same day as the screening mammogram. The screening mammogram should be billed with the appropriate code (such as 77067) along with modifier 59 (Distinct Procedural Service) to bypass NCCI edits.

It is important to document the medical necessity for both exams in the patient’s record and to follow specific billing rules and guidelines to ensure accurate and compliant billing practices for mammography services. Consulting with billing and coding experts or compliance officers within healthcare organizations is recommended to navigate the complexities of billing for screening and diagnostic mammograms effectively.

Examples of CPT Code 77067?

Scenario 1: A 45-year-old woman with no personal history of breast cancer visits her primary care physician for her annual well-woman exam. As part of the visit, the physician orders a screening mammogram for the patient as recommended by guidelines. The radiology center performs a bilateral screening mammography with 2-view imaging of each breast, supplemented by Computer-Aided Detection (CAD) to aid in the detection of any potential abnormalities.

Scenario 2: A 55-year-old woman with a family history of breast cancer presents to her gynecologist for a regular check-up. Given the patient’s increased risk due to her family history, the gynecologist advises her to undergo a screening mammogram. The radiology facility conducts a bilateral screening mammography using CPT Code 77067, including CAD to assist in the interpretation of the mammogram images and improve the accuracy of detecting any suspicious findings.

Scenario 3: A 50-year-old female visits her healthcare provider for her annual routine screening mammogram. The radiology technician performs a two-view study of each breast to capture comprehensive images. The images are then analyzed using Computer-Aided Detection (CAD) software, which assists the radiologist in identifying any suspicious areas that may warrant further investigation. The combination of advanced imaging techniques and CAD software helps improve the accuracy of detecting potential abnormalities, ultimately aiding in the early detection of breast cancer. This scenario exemplifies the utilization of CPT Code 77067 for Screening Mammography, Bilateral, with CAD, showcasing a modern approach to breast cancer screening that prioritizes early detection and improved patient outcomes.