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
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
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.
Kim Snyder, CPC
Director, Physician Education
MSN Healthcare Solutions