The 2015 Current Procedural Terminology (CPT®) changes for reporting breast imaging procedures have resulted in several questions regarding reporting of the new codes for breast ultrasound and breast tomosynthesis. The following details should help clear up questions related to the new CPT codes.
- The new codes will be reported for unilateral breast ultrasound imaging and allow coding one procedure per breast, per session, using a bilateral indicator of RT and LT as applicable.
- A complete exam will consist of examination of all four quadrants of the breast and the retroareolar region, as well as examination of the axilla when performed.
- The limited exam will be reported for examination of the breast when all the elements are not included.
- If only an axillary ultrasound examination is performed, CPT instructional note directs the coder to use 76882, Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific.
- These are stand alone codes and may be reported when performed alone or when performed with other services (e.g., diagnostic film mammography, 77055 or 77056).
- The Medicare Physicians Fee Schedule assigns as status “I” indicating the codes are not valid for Medicare purposes.
- CMS created a new add-on G code (G0279) to be used with the existing digital diagnostic mammography codes (G0204, G0206)
- Report in conjunction with 77057 Screening mammography, bilateral (2-view film study of each breast) or G0202 Screening Mammography, producing direct digital image, bilateral, all views
Per CPT instructional notes, Digital Breast Tomosynthesis codes are not to be reported in conjunction with three-dimensional (3D) codes 76376 and 76377.
CMS has indicated in the final rule, that it is “making a change in the descriptors to make clear that the G0202, G0204, and G0206 are specific to 2-D mammography. These codes are to be reported with either G0279 or CPT code 77063 when mammography is furnished using 3-D mammography. After consideration of public comments, we are modifying our proposal as follows: we will include CPT codes 77055, 77056, and 77057 on the potentially misvalued codes list; we will continue to recognize G0202, G0204 and G0206 but will modify the descriptors so that they are specific to 2-D digital mammography, and instead of using the digital values we will continue to use the CY 2014 work and PE RVUs to value the mammography CPT codes. We expect that the CPT Editorial Panel will consider the descriptor for screening mammography, CPT code 77057, in light of the prevailing use of digital mammography.”3