Posted and filed under Coding, Medical Record Auditing, Payers.

In honor of Breast Cancer Awareness Month, we’ve decided to release a brief reminder to not only schedule a routine mammogram, but to recall the 2017 Mammogram Coding Changes.

Mammography Coding

The Centers for Medicare and Medicaid Services (CMS) announced in November 2016’s final rule that they would not be able to accommodate the new 2017 coding system detailed in the 2017 CPT updates. For this reason, providers were instructed to continue using HCPCS codes G0202-G0206 until the new code sets could be fully adopted. As a form of compromise, CMS changed the definitions of these codes to mirror the 2017 CPT codes.

The Breakdown

There were 3 new codes in the 2017 CPT code set.

  • 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • 77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

These codes can be used for both digital and non-digital mammograms.

Three applicable HCPCS codes were revised to match their new CPT counterparts:

  • G0202 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
  • G0204 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • G0206 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

Codes G0202-G0206 now include CAD when performed. They too can be used for both digital and non-digital mammograms.

It is important to note that if the mammogram is taken using film, then the modifier FX will need to be applied on the Medicare claim for the technical component, regardless of the place of service.