Opting for outsourced radiology medical coding services is a feasible strategy for imaging specialists in 2017. There are changes to mammography codes in 2017, with some codes being deleted and new ones being introduced. Providers closely track coding for mammography with CAD as mammography payment rates were set differently from the traditional analysis of procedure cost inputs by the Relative Value Unit Update Committee (RUC). Expert coders keep track of these developments to help radiology practices maximize reimbursement for breast imaging services. Screening and diagnostic mammography is performed to check for abnormal changes in the breast. Screening mammography done on asymptomatic women can detect malignant breast pathology at an early, potentially curable stage. The aim of diagnostic imaging on a symptomatic patient is to typify the abnormality found during the screening to arrive at a diagnosis.
CPT Code Changes for Mammography in 2017
The changes to mammography codes in 2017 are as follows:
- Three codes have been deleted:
- 77055 Mammography; unilateral
- 77056 Mammography; bilateral
- 77057 Screening mammography, bilateral (2-view study of each breast)
- The deleted codes are replaced by one set of three mammography codes that bundle codes for digital mammography, film screen mammography and computer-aided detection (CAD) mammography:
- 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
Medicare to Retain Existing G-codes
The new CPT codes for mammography are structured similar to the existing codes without CAD and are parallel in nature to the existing G-codes G0202, G0204 and G0206:
- 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
The Centers for Medicare and Medicaid Services (CMS) is delaying the adoption of the new bundled CPT codes – 77065, 77066, and 77067 – for a year for reasons related to claims processing systems. Therefore, for Medicare purposes, breast tomosynthesis or three-dimensional (3D) mammography services should be reported using the applicable mammography code along with the applicable add-on tomosynthesis code. The add-on codes used to describe breast tomosynthesis are as follows: 77063 Screening digital breast tomosynthesis, bilateral (to be listed separately in addition to code for primary procedure) G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (to be listed separately in addition to G0204 or G0206) For breast tomosynthesis, CMS instructs imaging service providers to report:
- One of G0202, G0204, or G0206
- One of G0279 or 77063
To bill digital breast tomosynthesis, the appropriate, the accompanying 2D image (s) may either be acquired or synthesized.
2017 Medicare Physician Fee Schedule (MPFS) – Benefits for Radiologists
The benefits of the 2017 Medicare Physician Fee Schedule (MPFS) rule for radiologists include:
- A 0.04 increase in the relative value unit (RVU) for mammography, which experts say should not be overlooked
- The proposed cuts to the technical component reimbursement have been put on hold, which avoids a potential decrease of 50 percent in technical component reimbursement for 2017
Unlike large medical centers, smaller imaging providers would have been affected by the cuts and rendered unable to provide mammography services. Delaying the cuts will enable smaller imaging facilities to serve beneficiaries who would otherwise have to approach large medical centers in the cities for screening and later for diagnostic mammography or surgical consultation, if there are clinically significant images. Reliable radiology medical coding companies stay up to date with changes in radiology medical billing and coding as they occur and are committed to helping providers maximize revenue collection from all payers. To learn more about G codes for Mammography with CPT Codes, see our new blog “CMS Replaces G codes for Mammography with CPT Codes“, published on February 5, 2018.
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