Breaking Down Digital Breast Tomosynthesis

With the great resignation creating knowledge gaps, Medicare reimbursement constantly under threat of reduction, coding complexities, and endless opportunities for errors, now is the time to reinforce your bottom line with accurate coding. Digital Breast Tomosynthesis (DBT) carries serval distinct codes each with their own complexities that could spell confusion for coders. We have tips and rationale that will help clear the confusion. By mastering these codes, you can enhance both your professional expertise and compliance success.

Cracking into Coding Comprehension

The following codes are associated with DBT:

• 77061 Diagnostic digital breast tomosynthesis; unilateral
• 77062 Diagnostic digital breast tomosynthesis; bilateral
• +77063 Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)
• +G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)

CPT® codes 77061, 77062 and +77063 and HCPCS Level II code +G0279 were added in 2015 for reporting digital breast tomosynthesis (DBT) services. DBT is a revolutionary tomographic technique that utilizes multiple low-dose X-ray exposures to capture images of the breast. These images can then be reconstructed on a computer workstation, providing valuable assistance in interpreting both screening and diagnostic mammograms. Unlike conventional screening mammography, which typically generates four views, DBT has the potential to generate as many as 200 views. This enhanced imaging capability significantly increases sensitivity and specificity in breast cancer screening.

Let’s take a closer look at the specific CPT codes related to DBT. Codes 77061 and 77062 can be reported as stand-alone diagnostic breast tomosynthesis or in conjunction with standard mammography (codes 77065 and 77066).

However, it’s important to note that CPT code +77063 is an add-on code specifically intended for screening digital breast tomosynthesis. This code must be billed in conjunction with a standard mammogram (code 77067). The Centers for Medicare and Medicaid Services (CMS) have adopted this code based on the U.S. Food and Drug Administration’s (FDA) requirement that a standard mammogram must accompany DBT when used for screening purposes. CMS created diagnostic digital breast tomosynthesis add-on code +G0279 for use with diagnostic mammography codes 77065 or 77066 (as of January 1, 2018) for either unilateral or diagnostic mammography with DBT. Thus, there currently isn’t a way under Medicare to report diagnostic DBT performed without mammography.

• For Medicare reporting purposes, refer to the following matrix, which became effective January 1, 2018:

What are the rules for reporting these codes with other codes? For non-Medicare insurers, 77061 and 77062 (diagnostic breast tomosynthesis) may be reported in conjunction with 77065 and 77066 as appropriate. Note that add-on code +77063 (bilateral screening breast tomosynthesis) may be reported with 77067. However, do not report a 3D reconstruction code (76376 or 76377) in conjunction with full-field digital mammography.

Several states now mandate payment for DBT, though some payers may still consider digital breast tomosynthesis investigational and, therefore, not covered. However, it should still be reported when performed. Consult with your payers for additional guidance and coverage policies relevant to your facility. Assign revenue code 0403 if utilized in conjunction with screening mammography or revenue code 0401 if utilized in conjunction with diagnostic mammography. Assign modifier 26 to describe the professional component when technical services provided are hospital-based.

These are not all the knowledge tips necessary for correct and compliant mammography coding. As service volumes rebound, now more than ever, it is imperative to make sure your CPT® coding is as accurate as possible. Purchase our nationally renowned Breast & Bone Density Procedure Coder for full coding education coverage in 2023.