Mammography is a crucial procedure for detecting breast cancer. However, do oncologists exclusively perform mammography for diagnostic purposes? The answer is NO! Physicians also perform mammography as a routine test on asymptomatic women. These screening mammographies help in identifying early signs of breast cancer, such as lumps, masses, and microcalcifications, especially in women who are considered high risk.
But how will insurance payers distinguish between screening and diagnostic mammographies? CPT codes are essential for identifying the different kinds of mammographies that medical professionals perform. Considering the importance of mammography CPT codes, we will discuss CPT code 77067 in this blog and offer its comprehensive explanation.
CPT Code 77067 – Description
CPT code 77067 represents “screening mammography”. It is a bilateral screening mammography, with a diagnostic technique that involves a two-view study of each breast. The physician utilizes an FDA-approved technique called computer-aided detection (CAD) for routine breast cancer screening. This comprehensive procedure helps detect early signs of breast cancer (potential abnormalities) in asymptomatic women.
In simple words, the provider obtains two X-ray views of each breast for routine screening. He performs this process with the help of specially designed computer software, which analyzes the images and converts signals into digital data.
Scenarios Where CPT Code 77067 is Applicable
The description was just general information about the code. The following scenarios will help you understand the accurate use of CPT code 77067.
Follow-Up Screening
Suppose a 50-year-old woman who was previously diagnosed with breast cancer is scheduled for her yearly screening for breast cancer prevention. Although she visits the hospital with no physical signs of re-development of the lumps in her right breast, the radiologist utilizes CAD technology to effectively detect any potential signs of cancer in the other breast and remission in the right breast.
Since the radiologist conducts a bilateral screening mammography using CAD technology, he can bill his services with CPT code 77067.
Employer-Sponsored Health Checkup
Suppose a company is conducting a breast cancer awareness day as part of the “PINKTOBER”. The employer has taken measures to promote awareness by collaborating with an oncology practice. She asks every woman who is older than 40 to get a preventive breast cancer checkup.
So, a 45-year-old female employee visits the oncology practice for a screening mammography. The radiologist present at the practice performs a bilateral mammography using CAD technology. In this scenario, the patient undergoes a bilateral mammography with computer-aided detection (CAD). So, the radiologist can apply CPT code 77067.
Routine Preventive Checkup
Most women visit oncology clinics for routine screening as a preventive measure against breast cancer. So, let’s imagine a 40-year-old woman visits your clinic for a yearly checkup. You perform a bilateral mammography to check for any specific breast concerns or signs of cancer. Since you perform a bilateral mammography with CAD technology, you can use CPT code 77067 to bill your services.
Applicable Modifiers for CPT Code 77067
You can apply the following modifiers with CPT code 77067 to provide additional information to the insurance payer.
Modifier 26
How do you charge for professional services, like interpreting the mammograms and reporting the results? Modifier 26 will represent the professional component of your services. You can use it with CPT code 77067 to bill only for your part in the procedure.
Modifier TC
The radiology lab would bill for the technical component with the TC modifier. It specifies billing for equipment use and the staff member’s time performing the imaging procedure. Use modifier TC with CPT code 77067 when you are only charging for the technical component of a bilateral screening mammography.
Modifier 52
If your bilateral mammography service was reduced to one breast’s viewing and imaging only due to a prior mastectomy, you can apply modifier 52 with CPT code 77067. It identifies the reduced service. However, this modifier can also lead to reduced payments.
CPT Code 77067 – Billing & Reimbursement Guidelines
The following billing and reimbursement guidelines can help you file clean and compliant claims for CPT code 77067.
Maintain and Submit Supporting Documentation
An oncologist or radiologist reports the nature of their mammography services to get accurate reimbursements from insurance payers. In addition to this, proper documentation enables medical professionals to justify the medical necessity of mammography procedures. Therefore, your paperwork must include the following components:
- An indication of whether unilateral or bilateral mammography
- The reason for the test
- Description of the test
- The interpretation and results
- Referring physician’s name
Ensure Accurate Coding
Along with correct documentation, accurate coding is also essential. You must select the appropriate mammography CPT code. For example, apply CPT code 77067 for standard screening mammographies that involve imaging of both breasts. If you conduct mammography of one breast or forget to mention the use of CAD technology, it may lead to claim denials or reduced reimbursements.
Furthermore, if a patient is exhibiting any symptoms of breast cancer or you are conducting bilateral mammography for diagnostic purposes, you can not use CPT code 77067. Why, because this code only represents screening mammography for asymptomatic women.
Pay Attention to Frequency Limits
Medicare Part B covers a screening mammography if performed once every 12 months. Moreover, the female patient must be 40 or older. However, this frequency limit may vary for commercial payers. So, you must check each payer’s specific policies before billing a screening mammography.
Conclusion
Understanding the correct use of CPT code 77067 is important for radiology coders and billers. Accurate billing requires knowledge of the CPT codes, mammography exam types, and particular documentation needs. Most healthcare providers get confused between bilateral and unilateral breast screening, and even between screening and diagnostic mammography.
This blog has clearly stated that CPT code 77067 represents a screening mammography of both breasts with CAD technology. Furthermore, clinical scenarios have thoroughly explained the correct uses of this code.
If you are still confused about the billing of this code, you can consider professional radiology billing services for better guidance and support. Outsourcing can reduce the chances of billing errors.
