Distinguish Screening and Diagnostic Coding for Mammography

Mammography screenings provide earlier detection, resulting in prompt treatment of breast cancer. It’s important when entering codes for mammography billing to differentiate between screening and diagnostic services. Screening services are preventive for asymptomatic women, whereas diagnostic mammography is for men or women with evidence of breast disease.1

Screening mammography services usually involve two X-rays of each breast and can detect tumors that cannot be felt. It can also find microcalcifications that sometimes indicate the presence of breast cancer.

CPT/HCPCS Codes for Screening Mammography

  • 77052 (in conjunction with 77057): Computer-aided with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography. (List separately in addition to code for primary procedure.)
  • 77057 (in conjunction with 77052): Screening mammography, bilateral (2-view film study of each breast) for computer-aided detection applied to a screening mammogram.
  • G0202: Screening mammography, producing direct digital image, bilateral, all views.

Diagnostic mammography checks for breast cancer after the discovery of a lump or other sign or symptom of breast cancer. These signs may include pain, skin thickening, nipple discharge or a change in breast size or shape. Diagnostic mammography is not a preventive service.

CPT/HCPCS Codes for Diagnostic Mammography

  • 77051 (in conjunction with 77055 or 77056): Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography. (List separately in addition to code for primary procedure.)
  • 77055 (in conjunction with 77051 for computer-aided detection applied to a diagnostic mammogram): Mammography; unilateral.
  • 77056 (in conjunction with 77051 for computer-aided detection applied to a diagnostic mammogram): Mammography; bilateral.
  • G0204: Diagnostic mammography, producing direct digital image, bilateral, all views.
  • G0206: Diagnostic mammography, producing direct digital image, unilateral, all views.

Providers should use code 77052 in conjunction with code 77057 and code 77051 with code 77056 when billing for mammography screenings.

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http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Mammography-ICN907790.pdf

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