October 31, 2014

ACR Radiology Coding Source™ September-October 2014 Q and A 

Q: The state of Indiana has recently passed a law for women with dense breasts. It states that we are to notify them of this and their higher risk of breast cancer plus it states insurance will have to now provide coverage for screening ultrasounds. Can you please tell me how should we code the screening breast ultrasound exams? Unfortunately the law does not give us this information.

A: For the remainder of 2014 the appropriate CPT® code to report an ultrasound examination of the breast is 76645 (Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation). For 2015, there will be new breast ultrasound codes to replace 76645. Code 76645 will be deleted. 

The CPT 2015 codebook reads: 

Code 76641 represents a complete ultrasound examination of the breast. Code 76641 consists of an ultrasound examination of all four quadrants of the breast and the retroareolar region. It also includes ultrasound examination of the axilla, if performed. 

Code 76642 consists of a focused ultrasound examination of the breast limited to the assessment of one or more, but not all of the elements listed in code 76641. It also includes ultrasound examination of the axilla, if performed. 

Therefore, beginning on January 1, 2015, the complete examination is reported with code 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete, with the appropriate modifier (e.g., RT, LT) when bilateral studies are performed. It should be noted that unlike the deleted code 76645, the 2015 codes 76641 and 76642 describe unilateral procedures. 

Whenever a screening examination is performed, the ICD-9 screening diagnosis code is the first-listed, regardless of the findings or any procedure that may be performed as a result of the findings. An ultrasound screening examination of the breast should be reported with ICD-9 code V76.19 (Special screening for malignant neoplasm, other screening breast examination). It is recommended that a secondary diagnosis be reported (e.g., 793.82, Inconclusive mammogram – dense breasts NOS) to communicate to the payer that the study was performed to a high risk patient.