Is History of Breast Cancer Justification?
Many local policies follow the lead of the Health Care Financing Administration (HCFA) and allow radiologists to assign diagnostic mammography codes (76090, mammography; unilateral; or 76091, bilateral) to patients who have had a personal history of breast cancer. For example, the local Medicare policy in Pennsylvania allows reimbursement for diagnostic mammograms for men or women who have a personal history of breast cancer (V10.3), along with those who exhibit signs and symptoms of breast disease (i.e., lump or mass in the breast611.72) or have a personal history of biopsy-proven benign breast disease (i.e., solitary cyst of breast610.0). Similar coding requirements can be found in Connecticut. According to Darlene Zase, BS, CMPE, administrative director for Bridgeport Radiology Association in Fairfield, Conn., radiologists there are allowed to bill mammography as diagnostic for at least five years after patients have been treated for cancer. (Five years post-therapy is often accepte
