Breast cancer is one of the most common types of cancer among women. However, the survival rate increases if it is detected in the early stages. To assess how advanced a person’s breast cancer is and whether it has metastasized beyond the breast, a stage is assigned at the time of diagnosis. The most effective way to avoid being diagnosed with late-stage breast cancer is through early detection via yearly mammograms and other breast examinations.
CPT code 77066 is a diagnostic mammography code that is used in the diagnosis of breast cancer. But how will you bill this code? And how can you overcome the challenges encountered while filing claims for this CPT code? Continue reading for the answers.
CPT Code 77066 – Description
CPT code 77066 represents a diagnostic mammography, an X-ray procedure that examines breast tissue for irregularities.
The technician performs X-ray imaging on both breasts of a patient who has a lump or is suspected of having cancer, and may utilize specialized computer software (computer-aided detection or CAD) to identify or diagnose potential issues in the images. This software uses artificial intelligence (AI) and machine learning to transform signals into digital data and evaluate the mammograms. So, simply put, CAD technology helps radiologists spot probable concerns more effectively.
Scenarios Where CPT Code 77066 is Applicable
The following are some real-life scenarios for CPT code 77066.
Monitoring Previous Cancer Sites
Suppose a 35-year-old woman who was earlier diagnosed and treated for breast calcifications (buildup of calcium salts within breast tissue) returns for her bi-annual follow-up six months later to see if the calcifications have altered. To evaluate changes in known abnormalities and ensure that no new findings have emerged in her breast, the physician orders a bilateral diagnostic mammography on both breasts, rather than concentrating solely on one breast. The radiologist performs the medically required diagnostic X-ray of both breasts and reports the service with CPT code 77066.
Abnormal Findings in the Screening
A yearly screening mammography is performed on a 50-year-old woman. The screening images are insufficient to provide a definitive diagnosis, but the radiologist observes an area of asymmetry in the left breast. Taking into account the radiologist’s findings, the physician orders a bilateral diagnostic mammography (covered by CPT code 77066) to thoroughly assess the suspicious area and rule out any anomalies in the other breast for comparison. The radiologist acts on the order and obtains more focused images of both breasts. Hence, he reports the procedure with code 77066.
Applicable Modifiers for CPT Code 77066
The following are some of the relevant modifiers for CPT code 77066.
Modifier TC
The modifier TC can be appended to the 77066 CPT code when only the technical component of the service is being billed. This includes charging for the equipment, supplies, and the technician’s time and effort.
Modifier 26
You can add modifier 26 to CPT code 77066 to indicate that you are only billing for the physician’s professional component of the service. This means charging for the physician’s interpretation of the mammogram and reporting of the findings.
Modifier 59
Modifier 59 may be necessary if CPT code 77066 is reported on the same day as another procedure performed on the same patient. It indicates that two services were distinct and separately reimbursable.
CPT Code 77066 – Billing & Reimbursement Guidelines
You must follow the mentioned guidelines to avoid claim denials on CPT code 77066.
Ensure Correct Use of CPT 77066
You cannot just limit your understanding to the description of one particular code. You have to understand the nature of other relevant codes as well to bill your service accurately. Suppose you are performing diagnostic mammography on just one breast and applying CPT code 77066 to report the diagnostic procedure. This would be considered a wrong application of the code. In this case, you should have reported CPT code 77065.
Provide Detailed Documentation
Comprehensive documentation is required by nearly all payers, including commercial payers and federal programs like Medicare. It gives payers the information they need to verify the procedure’s medical necessity. Thus, make every effort to guarantee its accuracy and completeness. The following should be included in your CPT code 77066 documentation:
- The patient’s age and the date of their most recent screening mammography. This data aids in determining if the billed service falls under the payer’s annual frequency cap.
- The physician’s order for a digital bilateral breast tomosynthesis.
- The patient’s condition and symptoms, such as pain, nipple discharge, palpable mass, etc.
- The interpreting provider’s official, signed report.
Append the Relevant Modifiers
Before you decide to append modifiers to CPT code 77066, you must understand the nature of this code. This code represents a bilateral mammography, which means you cannot append modifier 50 (indicating the bilateral services) or modifier LT/RT(representing the side of the body) with this code.
Final Word
In summary, CPT code 77066 reports a bilateral diagnostic mammography, including computer-aided detection (CAD) when performed. By appending the proper documentation and modifiers and following the guidelines mentioned in this blog, you can accurately file claims for this code.
But if you think that this information is insufficient to code your claims correctly, you can opt for professional radiology billing services. Experts offering these specialized services know which diagnostic test codes to report and what documentation to include for error-free claim submissions.
