Article from the January/February 2003 ACR Radiology Coding Source
Mammography Computerized-aided Detection (CAD) [H3]
For 2003 there has been a change in the coding for mammography procedures that make use of computer-aided detection imaging. The Centers for Medicare and Medicaid Services has published a Program Memorandum (MCM #1775;MIM #1864) advising that Medicare will cover not only CAD performed in conjunction with film converted to digital mammography, but as of April 1, 2003 will also cover the use of CAD when performed in conjunction with direct full-field digital mammography.
Although the 2003 CPT® code descriptor for +76085 specifies “digitization of film radiographic images,” CMS is instructing providers to use the add-on CPT® code +76085 to describe CAD used in conjunction with HCPCS level II code G0202 for direct digital screening mammography. Therefore, as of 4/1/03, it would be appropriate to submit code +76085 in conjunction with screening mammography codes 76092 (screening mammography) and G0202 (direct digital screening mammography) when CAD is performed.
CMS revised the 2003 HCPCS code descriptor for CAD (+G0236) to include the phrase “or computer analysis of digital mammogram for lesion detection.” As of 4/1/03, it is appropriate to use code +G0236 to describe CAD performed in conjunction with diagnostic mammography codes 76091 (bilateral diagnostic mammogram), 76090 (unilateral diagnostic mammogram), G0204 (bilateral diagnostic direct digital imaging) and G0206 (unilateral diagnostic direct digital imaging).
The ACR has submitted a request to the CPT Editorial Panel for a 2004 CPT® descriptor change to code +76085 so that this code will appropriately describe the use of CAD associated with either “film-to-digital” or “full-field digital” mammography.
As noted in the HCPCS 2003 manual, payment of direct digital imaging is at the carrier’s discretion.
