What CPT (Current Procedural Terminology) code is reported for a bilateral screening mammography with Computer-Aided Detection (CAD) for a non-Medicare patient?

CPT Coding for Bilateral Screening Mammography with CAD

The correct CPT code for a bilateral screening mammography with Computer-Aided Detection (CAD) for a non-Medicare patient is 77067.

Understanding Mammography CPT Codes

When coding for mammography services, it's essential to understand the distinction between screening and diagnostic examinations, as well as the inclusion of Computer-Aided Detection (CAD) in current coding practices.

Screening vs. Diagnostic Mammography

• Screening mammography is performed on asymptomatic women to detect breast cancer when there are no signs or symptoms of breast disease.
• Diagnostic mammography is performed when there are signs or symptoms of breast disease, a history of breast cancer, or an abnormal finding on screening mammography.

Computer-Aided Detection (CAD)

Computer-Aided Detection has become an integral part of mammography interpretation. CAD systems:

• Use algorithms to identify suspicious areas on mammograms
• Help radiologists detect potential abnormalities that might otherwise be missed
• Have been shown to increase cancer detection rates by approximately 19.5% compared to interpretation without CAD 1

Code Analysis and Selection

Let's analyze each of the potential codes:

• 77062 - This is not a valid CPT code for screening mammography with CAD
• 77066 - This code represents diagnostic mammography with CAD, bilateral
• 77059 - This is an outdated code that has been replaced in current CPT coding
• 77067 - This code represents screening mammography with CAD, bilateral

The American College of Radiology guidelines support the use of screening mammography as an effective tool for breast cancer detection, with digital mammography allowing for computer storage and manipulation of images 1. When CAD is added to screening mammography, the appropriate code for a bilateral examination is 77067.

Important Coding Considerations

1. Bundled Services: CAD is now bundled into the mammography codes and is not reported separately.

2. Patient Type Considerations: The question specifically mentions a non-Medicare patient. For non-Medicare patients, the standard CPT code 77067 is appropriate for bilateral screening mammography with CAD.

3. Documentation Requirements: Ensure documentation includes:

   • Indication for screening mammography
   • Bilateral nature of the examination
   • Use of CAD technology
   • Final assessment using BI-RADS categories

Common Pitfalls to Avoid

• Confusing screening with diagnostic mammography: Diagnostic codes (77065-77066) should only be used when evaluating a specific breast problem or symptom, not for routine screening.

• Using outdated codes: The CPT code set is updated annually, and using outdated codes will result in claim denials.

• Failing to recognize that CAD is included: Unlike in the past, CAD is now bundled into the mammography codes and is not reported separately.