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Answers to Compliance and Medical Coding Questions.
  1. Denise Posted 2 month(s) agoRelated Topics

    We have a disagreement between 2 of our radiologists in our Breast Center regarding the annual screening mammo of patients with a history of lumpectomy. One radiologists wants to routinely add a spot mag view of the lumpectomy bed for all patients who have a hx of lumpectomy as part of their annual screening mammo. Our other radiologist feels this is unnecessary, but more importantly, feels this puts us at risk as far as compliance by making a spot mag view part of our routine screening views for those patients; whereas, with other patients, it would be charged as part of a Diagnostic mammo. Are we setting a precident of performing additional, traditionally diagnostic, views without charging for them? Could this lead to us not being able to charge for the additional views we charge as a Diagnostic mammo for those patients that we need to call back?

  2. SuperCoder Posted 2 month(s) ago

    CPT code 77067 is a comprehensive code for bilateral breasts and restricted to 2-view study of each breast. If your radiologist doing 1 additional spot magnification view of lumpectomy bed along with 2-view conventional study, you can bill Add-on CPT +77063 along with CPT 77067, because Digital Breast Tomosynthesis technology (DBT) provides higher diagnostic accuracy compared to conventional mammography (both Diagnostic and Screening). Also, It is not recommended to bill 77065/77066 with CPT 77067, as CCI edits do not allows it.

  3. Denise Posted 2 month(s) ago

    The add on CPT 77063 is for 3D/Tomosynthesis. The question wasn't about an additional 3D image, but instead about a spot compression magnification view added on to a screening study. The concern is that we would be adding on a typically Diagnostic view (compression mag view) to a Screening study w/out any any additional charge for this patient population. Is this a compliance issue?

  4. SuperCoder Posted 2 month(s) ago

    During screening mammogram, if some suspicious area was identified by the radiologist and during the same encounter, if the radiologist order additional diagnostic views, referred as “magnification and spot compression.” For this circumstances, Medicare allows to bill both the screening mammogram and the appropriate diagnostic mammogram. To indicate that a screening mammogram has taken place and ended in the decision for a diagnostic service. To report medical necessity appropriately, be sure to link a screening ICD-10 CM code to the screening mammogram CPT code (/77067) and the diagnosis code for the abnormal finding to the diagnostic mammogram (77065/77066). Also, this doesn't seems like complaince issue, if your documentation supports the medical necessity. Still, if you are not satisfied with the response. Kindly elaborate the complaince issue, which your practice may face.

  5. Denise Posted 2 month(s) ago

    The radiologist is not reviewing these images prior to the additional spot compression magnification view; she wants the mammo tech to automatically perform the spot compression mag view as part of the screening exam and code the exam as a normal Screening Mammogram. The patient is discharged and the exam is then read as a Screening Mammo; there is no additional coding or charging for that additional view.

  6. SuperCoder Posted 2 month(s) ago

    For this scenario, you cannot bill any CPT code for additional spot compression magnification view along with Screening Mammography. Also, this will be an additional load (work & charges) on your facility, as you are not getting any reimbursement for this additional view. Furthermore, this will raise an alert to the federal body as your peer radiologists and practices are not doing it.

    Hope it answers your questions.

  7. Denise Posted 2 month(s) ago

    So, if our facility makes it our standard protocol that we do an additional spot compression magnification for all post-lumpectomy patients on their Screening Mammograms, regardless of how long ago the patient had the surgical procedure, and we don't charge anything additional for those patients, is there any concern at that point?

  8. SuperCoder Posted 2 month(s) ago

    As such there would be no concern. But this will impose an additional cost to your facility. To overcome this issue, we would recommend you to please get in touch with your radiologists, if they can get the desired findings/result through 3D/Tomosynthesis. Because then you can get paid additional for Tomosynthesis.

About this Question

  • Posted by 74933 Denise , 2 month(s) ago. There are 8 posts. The latest reply is from SuperCoder.