Reporting G Codes for Mammogram.
The American Medical Association (AMA) deleted CPT(R) 77051, 77052, 77055, 77056, and 77057, and introduced three replacement codes to report mammography for 2017.
- 77065Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
- 77066 bilateral
- 77067Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
The reason for the change is that the industry standard for mammograms now bundles computer-assisted detection (CAD) with mammograms.
The descriptors for these new codes mirror, exactly, the HCPCS Level II codes for reporting mammography services:
- G0202Screening mammography bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
- G0204Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
- G0206Unilateral
Codes G0202-G0206 are required when reporting mammography to Medicare payers. Codes 77065-77067 have not replaced G0202-G0206 for Medicare billing.
On Jan. 4, the Centers for Medicare & Medicaid Services (CMS) published an update to Change Request (CR) 9861 (originally released on Nov. 16, 2016) and its accompanying spreadsheets for the National Coverage Determinations (NCD) affected by the CR. Unexpectedly, CMS added a note in the Revision History for NCD 220.4 Mammograms, stating that it would not recognize the 2017 CPT(R) codes for mammograms. CMS explained, ?This is the result of being unable to properly process claims using CPT codes 77065, 77066, and 77067 for 2017.? CMS said that it intends to recognize the 2017 CPT(R) codes for mammograms in 2018.
For Professional Mammography Services:
For 2017 professional (practitioner?s) claims, report mammography services using the G-codes (G0202, G0204, G0206, G0279) or 77063. Be sure the service ordered and performed matches the description of the code. It is easy to confuse screening versus diagnostic and the accompanying tomosynthesis codes.
The CMS spreadsheet updated and released on Jan. 4 for CR9861 is confusing; it still contains the expired CPT(R) codes, but you may not use them for dates of service past Dec. 31, 2016.
For Medicare:
A screening mammogram without tomosynthesis is coded G0202. If the patient also has screening tomosynthesis add 77063. Be sure to check the NCD for the covered diagnoses and allowable frequency.
A diagnostic mammogram is coded as either G0204 (diagnostic bilateral) or G0206 (diagnostic unilateral). If tomosynthesis is ordered, also report G0279 to either G0204 or G0206, as appropriate.
For Commercial Payers:
Payers other than Medicare will likely use the new CPT(R) codes, but check with them to be sure. If a payer is using the CPT(R) codes, a screening mammogram is coded as 77067. If tomosynthesis is ordered, also report 77063.
For commercial diagnostic mammograms, code either 77065 or 77066, depending on the order. If tomosynthesis is provided, also report G0279.
Codes 77065-77067 have not replaced G0202-G0206 for Medicare billing