Question

Raja Lautu is a 42-year-old woman who had a (screening) digital mammogram with CAD (computer-aided detection) performed recently as part of her physical examination (she is a new patient for Dr. Williams and BWW Medical Associates). When the mammogram revealed a small density in the right breast, a complete ultrasound of this breast was ordered with stereotactic breast biopsy. Considering Raja’s family history reveals that both her mother and maternal aunt have had breast cancer, she is understandably nervous about this development.

Discussion Questions

1. What is the correct CPT code for the physical examination that was performed on Raja?

2. Code the screening bilateral mammogram using both the CPT and HCPCS coding references. Which payer will require the HCPCS code instead of the CPT?

3. Using the CPT manual, code the ultrasound of the breast and the breast biopsy. Include any necessary modifiers.

Answer 1

The correct CPT code for the physical examination that was performed on Raja are - 99386 (Initial comprehensive preventive medicine evaluation and management) and 99396 (Periodic comprehensive preventive medicine reevaluation and management)

The screening bilateral mammogram using both the CPT and HCPCS coding references are CPT- 77057 (bilateral screening mammography) and 77052 CAD (screening mammography using computer-aided retention)
HCPCS- G0202(Screening mammography, bilateral using computer-aided detection (cad) when performed) and 77052 CAD will require the HCPCS code instead of the CPT.

76645 (breast ultrasound) and 19081-RT (biopsy performed on first lesion, right breast)