Breast Cancer is the most common type of cancer in women in the United States. However, there are screening procedures available to diagnose breast cancers in the early stage.

We are listing the Breast Cancer Screening ICD and CPT Codes invloved in the diagnoses and procedures coding for screening malignant neoplasm of the breast.

Screening is the testing for diseases in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. If testing is performed because the patient has a sign or symptom, the sign or symptom code is used to explain the reason for the test, not the screening code.

A screening code may be the first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an encounter for other health problems. If a condition is discovered during the screening, the code for the condition may be assigned as an additional diagnosis.

Breast Cancer Screening ICD 9 and CPT Codes

The following ICD 9 V Code categories are reported to indicate that a screening exam is planned. A procedure code is also required to confirm that the screening was performed. ICD 9 V73-V82 Special screening examinations are used for the purpose.

Breast Cancer Screening ICD 9 and CPT Codes

When the reason for performing a test is because the patient has had contact with, or exposure to, a communicable disease, the appropriate code from category V01, Contact with or exposure to communicable diseases, should be assigned, not a screening code.

ICD 9 Codes for Breast Cancer Screening Mammograms

Every woman is at risk for developing breast cancer, and the risk increases with age. According to the Center of Disease Control and Prevention (CDC), approximately 94 percent of breast cancers are diagnosed in women older than age 40. Mammography is the best available way to detect breast cancer early, when it is most curable. Timely screening can reduce breast cancer mortality in women 40 and older by 17 percent to 30 percent.

The National Cancer Institute (NCI) guidelines for screening mammography recommend that asymptomatic women 40 years or older be screened every 1 to 2 years and women aged 50 or older be screened every 1 to 2 years. NCI further recommends that younger women who are at higher risk for developing breast cancer consult with their physician regarding screening mammography and the frequency of such screenings.

Diagnostic mammograms differ from screening mammograms. Screening mammograms are for patients without documented problems. Diagnostic mammograms are performed when there is a problem such as a breast mass, pain, discharge, etc. Code any positive findings found on the diagnostic mammogram as the first listed diagnoses. If there are no reported findings, assign the reason for the test. The ICD 9 diagnoses codes for encounters for screening mammogram are:
  • V76.11 and V76.12 Special screening for malignant neoplasm, other screening mammography.
  • V76.11, Special screening for malignant neoplasm, screening mammogram for high-risk patients.
Example: A healthy 40-year-old woman presents to the radiology department for a screening mammogram. The patient has no symptoms or known risks for breast cancer. Assign code V76.12.
The following ICD 9 codes may be assigned with code V76.11 to identify why the patient is considered to be at high-risk:
  • V10.3, Personal history of malignant neoplasm, breast
  • V16.3, Family history of malignant neoplasm, breast
  • V15.89, Other specified personal history presenting hazards to health, other
Example: A woman with no symptoms is referred to the hospital for screening mammogram. The patient is considered high risk for breast cancer secondary to family history of breast malignancy in the mother and sister. Assign code V76.11 followed by code V16.3.
If a condition is found during the screening, then the code for the condition may be used as an additional diagnosis. The rationale for this is that even though a condition is found during the mammography, the visit is still considered a screening.

For Medicare services, diagnosis codes V76.11 and V76.12 must be the first listed diagnosis on all encounters for screening mammography services. However, effective Oct. 1, 2006, this requirement will change to allow the reporting of any applicable diagnosis code as a primary diagnosis on claims containing other services in addition to a screening mammography. Continue reporting diagnosis codes V76.11 and V76.12 as the first listed diagnosis codes on claims that contain only screening mammography services.

Breast Cancer Mammography CPT Codes

A mammogram is a low-dose X-ray of the breast that can find lumps that are too small to be felt during a breast examination. The breast is compressed firmly between two planes and pictures are taken. This spreads the tissue and allows for a lower X-ray dose. A screening mammogram is used to detect breast changes in women who have no signs of breast cancer. When the patient has signs or symptoms of a suspected disease then a diagnostic mammogram is performed and coded instead.

A screening mammogram is inherently bilateral and is reported with Breast Cancer Screening CPT Codes 76092 and G0202 given below:
  • 76092, Screening mammography, bilateral (two view film study of each breast)
  • G0202, Screening mammography, producing direct digital image, bilateral, all views
Code 76083, Computer aided detection (CAD); screening mammography, may be assigned as an additional procedure code when it is performed in addition to the primary procedure. The additional CAD code indicates that a laser beam was used to scan the mammography film and then the image was converted to digital data for computer analysis.

As mentioned earlier, if a condition is discovered during the screening, then the code for the condition may be used as an additional diagnosis. In this instance, if the radiologist performing the mammogram orders additional films based on the condition discovered during the screening mammogram, both may be coded.

When a screening mammogram is converted to a diagnostic mammogram on the same day append modifier GG, Performance and payment of a screening mammography and diagnostic mammography on same patient same day, to the diagnostic mammography code. Modifier GG indicates that the test changed from a screening test to a diagnostic test. If not performed on both breasts, it is also important to append the appropriate anatomic modifier, RT or LT, to indicate which side the diagnostic mammogram was performed on.

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