Undoubtedly, billing for digital breast tomosynthesis (CPT code 77063) can be a significant challenge for many radiology centers and radiologists.
It is an integral procedure when it comes to taking preventive measures for breast cancer. It offers superior accuracy in detecting abnormalities. However, errors while reporting this code can disrupt your practice’s revenue cycle.
From understanding modifier usage to ensuring complete documentation, missteps can lead to claim denials and payment delays.
Our billing specialists at MediBillMD have curated this comprehensive guide to help you gain the knowledge needed to bill CPT 77063 correctly.
Thus, if you are struggling with a high denial rate related to this CPT code, we recommend you read this guide till the end.
CPT Code 77063 – Description
CPT code 77063 covers bilateral digital breast tomosynthesis. It involves taking three-dimensional (3D) images of the breasts using X-rays from various angles. These 3D images help providers identify any abnormalities within the breasts. In comparison to traditional mammography, tomosynthesis offers better accuracy and reliable results.
Note that according to Medicare, the 77063 CPT code is an add-on code and should be listed with the primary procedural code, 77067.
Scenarios Where CPT Code 77063 is Applicable
Here, let’s take a look at some of the real-world clinical scenarios where CPT 77063 applies:
Routine Annual Screening
Did you know that breast cancer detection rates have significantly improved with digital breast tomosynthesis compared to traditional mammography? It has lowered false-positive findings by as much as 2.7 per 1,000 screenings.
Picture a 45-year-old female patient with no personal or family history of breast cancer. She visits the radiology center for a scheduled routine annual checkup that includes a bilateral breast tomosynthesis (CPT code 77063).
During the procedure, the radiologist takes images of both breasts from multiple angles, creating a clear, detailed picture of the breast tissue. Therefore, the radiologist can report CPT code 77063 for billing and reimbursement collection.
Screening For A High-Risk Patient
Assume a 38-year-old female patient with a family history of breast cancer. Since her mother was diagnosed at age 43, the primary care physician advised her to begin annual screenings earlier than the typical age. The aim is to detect any potential abnormalities earlier and take preventive measures.
Moreover, the physician orders a bilateral digital breast tomosynthesis (CPT code 77063) because the patient is at a higher risk of getting breast cancer. The physician recommended this technique over traditional 2D mammograms for its enhanced ability to detect small tumors that might be challenging to identify in standard images.
Patient with Dense Breast Tissue
Imagine a 50-year-old female patient whose initial mammogram results revealed that she has dense breast tissue. This condition makes it challenging to identify tumors on a standard 2D mammogram. Therefore, the physician orders a bilateral digital breast tomosynthesis (CPT code 77063) for her subsequent annual screening.
For context, tomosynthesis utilizes a 3D technology that takes thin, layered images, enabling the radiologist to scroll through the breast tissue. Moreover, it significantly reduces the chances of a false-negative diagnosis by helping providers to distinguish between any potential abnormalities and dense tissue.
Applicable Modifiers for CPT Code 77063
Listed below are some of the applicable modifiers for CPT 77063:
Modifier 26
Do you want to bill only for the professional component of the bilateral breast tomosynthesis? Append modifier 26 to CPT code 77063. It indicates that the physician only performed the interpretation and prepared a report of the 3D mammograms.
Modifier 59
Have you performed bilateral breast tomosynthesis on the same day for the same patient with a diagnostic mammogram? Do not forget to append modifier 59 to CPT code 77063 to indicate that it is a significant and distinct procedure eligible for a separate reimbursement.
But that’s not all! You must also append a modifier to the diagnostic procedure. Check out the description provided under modifier GG to find out the reason.
Modifier TC
Is the facility that handled the performance of the bilateral breast tomosynthesis separate from the physician who interpreted the 3D mammogram? If yes, report CPT code 77063 with modifier TC to highlight that you are only billing for the technical component (equipment, supplies, and other resources) of the service.
Modifier GG
What happens when a screening mammography, such as CPT code 77063, is performed on the same day as a diagnostic mammography (77065, 77066, or G0279)? You append modifier GG to the diagnostic mammography code to ensure rightful reimbursement for both procedures.
CPT Code 77063 – Billing & Reimbursement Guidelines
The following are key billing and reimbursement guidelines related to CPT 77063:
Do Not Bill CPT Code 77063 without A 2D Mammogram
As discussed before, bilateral digital breast tomosynthesis is an add-on code. Therefore, you cannot bill it without a 2D mammogram code (77067).
For context, CPT code 77067 covers two X–ray views of each breast. Additionally, it involves computer-aided detection (CAD) to identify any potential abnormalities within the images.
Understand the Global Nature of CPT Code 77063
CPT 77063 covers a global procedure. It means that it involves both the professional and technical components of the service. Therefore, you should report it without appending modifiers TC and 26 if an entity performs tomosynthesis and also interprets the findings of the 3D mammograms.
Focus on Documentation Completeness
Almost all payers from federal programs like Medicare to commercial payers require comprehensive documentation. It offers the details payers need to confirm the medical necessity of the procedure. Therefore, strive to ensure its completeness and accuracy at all costs. Here’s what your documentation for CPT code 77063 should involve:
- Document the patient’s age and date of last screening mammography. This information helps determine whether the billed service is within the annual frequency limitation set by the payer.
- Physician’s order requesting a digital bilateral breast tomosynthesis for screening.
- Confirm the asymptomatic status of the patient by clearly mentioning that the patient has no specific symptoms (e.g., pain, nipple discharge, palpable mass, etc.). It is an essential detail to include because if the patient has any of these signs and symptoms, then a diagnostic procedure would be more appropriate.
- Attach a formal, signed report from the interpreting radiologist.
Summary
With that, we have reached the end of this guide. However, before concluding, let’s quickly revisit everything that we have discussed in this comprehensive guide.
First, we explained the descriptor of CPT code 77063. It covers the bilateral digital breast tomosynthesis (3D mammography).
Next, we shared a few real-world clinical scenarios where this CPT code applies. These include patients with dense breast tissue, screening for high-risk patients, and routine annual screening.
We also listed a few applicable modifiers for accurately billing bilateral digital breast tomosynthesis, including 26, 59, TC, and GG.
Finally, we discussed the essential reimbursement and billing guidelines for CPT 77063. All these details will help you navigate the billing complexities surrounding tomosynthesis. However, if you still struggle, feel free to partner with MediBillMD for tailored radiology billing services.
