Significant Coding Changes to Breast Services

Breast Lump

Fifteen more anatomically specific codes for breast lump were added to ICD-10 October 1, 2017.

CMS deleted code N63 – unspecified breast lump from the National Coverage Determination for:

Percutaneous Image Guided Breast Biopsy

CPT codes 19081, 19082, 19083, 19084, 19085 and 19086

Mammograms

CPT Codes G0202, G0204, G0206, 77065, 77066, 77067.

CMS only added 12 of the new ICD-10 codes, to the NCD policy for coverage for dates of service October 1, 2017, but the codes will not be considered for payment until April 1, 2018.

 

Added ICD-10 codes

 

N63.11 Unspecified lump in right breast, upper outer quadrant N63.12 Unspecified lump in right breast, upper inner quadrant N63.13 Unspecified lump in right breast, lower outer quadrant N63.14 Unspecified lump in right breast, lower inner quadrant N63.21 Unspecified lump in the left breast, upper outer quadrant N63.22 Unspecified lump in left breast, upper inner quadrant N63.23 Unspecified lump in the left breast, lower outer quadrant N63.24 Unspecified lump in the left breast, lower inner quadrant N63.31 Unspecified lump in axillary tail of the right breast N63.32 Unspecified lump in axillary tail of the left breast

N63.41 Unspecified lump in right breast, subareolar N63.42 Unspecified lump in left breast, subareolar

 

Note

ICD-10 codes:

N63 – unspecified breast lump was deleted from the NCD effective 9/30/17.

 

N63.10 – Unspecified lump in the right breast, unspecified quadrant and

N63.20 – Unspecified lump in the left breast, unspecified quadrant were not added to the list of covered diagnosis.

 

It is important that documentation include both laterality and quadrant. CPT codes for Mammography

Procedure codes 77067, 77066, and 77065 to describe both analog and digital mammography exams will be effective January 1, 2018 and will replace codes G0202, G0204, and G0206.

 

Changes to National Correct Coding Initiative (NCCI)

 

CPT code 77063 – Screening digital breast tomosynthesis, bilateral is an add-on code describing screening digital tomosynthesis for mammography.

This procedure requires performance of a screening mammography producing direct digital images.

Beginning calendar year 2018 CPT code 77063 may be reported with CPT code 77067.

 

https://www.cms.gov/Regulations-and- Guidance/Guidance/Transmittals/2017Downloads/R1975OTN.pdf

 

By:

Kim Snyder, CPC

Director, Physician Education
MSN Healthcare Solutions