We raise awareness about breast cancer in October because, according to the Centers for Disease Control and Prevention, it is the second most frequent cancer among women in the country (CDC). About 264,000 new cases of female cases and 2,400 new instances of male cases are reported each year in the US. Women experience a death rate of 42,000 as opposed to 500 for men. By ensuring that the diagnosis and treatments of patients are accurately billed, medical coders have a unique chance to assist patients.


Learn about Breast Anatomy.

Understanding the breast anatomy and the different tissue types is crucial when describing a patient's diagnosis and treatments:



Milk is produced by glands called lobules.

Milk travels via ducts to the nipple.

The lobules and ducts are bound together by fibrous and fatty connective tissue.

Breast cancer has the potential to spread to nearby tissues, lymph nodes, and other parts of the body. To stop cancer from metastasizing and improve survival chances, early detection and treatment are crucial.



Take preventative action

When a patient reaches a particular age, insurance companies will pay for preventive examinations like mammograms, and an ultrasound may be required for further testing after a diagnosis.



Mammography CPT®, HCPCS Level II coding:



Screening mammography: 77067, G0279 As a preventive step, this service is provided to asymptomatic individuals once they reach a specific age or have a family history suggesting they need it. Medicare and several commercial payers list these procedures as once-in-a-lifetime for women aged 35 to 39, once every 12 months for women age 40 and older, or more frequently if necessary for medical reasons.



Diagnostic mammography: 77065-77066 If there are signs and symptoms of breast disease, a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease with a doctor's interpretation of the data, this service is covered by Medicare and many third-party insurance payers.



Both professional and technical components are present in these tests; therefore, when solely billing the physician's interpretation of the results, append modifier 26 Professional component or TC Technical component. If both components were handled by the provider, don't use either modifier.



A medical professional may also determine that a diagnostic breast ultrasound is required. Coding depends on whether all structures or only some of them are examined:



76641 Unilateral breast ultrasound with real-time image documentation, complete with the axilla



76642 Unilateral breast ultrasound with real-time picture documentation that includes the axilla when done; restricted



In a full ultrasound, the doctor looks at the retroareolar area as well as the upper outer (UO), upper inner (UI), lower outer (LO), and lower inner (LI) quadrants of the breast (the region within 2 cm from the nipple). A limited exam involves one to three locations being examined by the doctor.

The axillary region (low, mid, and apical) is observed or is supposed to be viewed in both codes. Due to its proximity to the upper extremity, the axillary region's anatomy is sometimes mistaken for that of an extremity or musculoskeletal tissue. The axilla may be examined by the doctor, but the majority of the test involves examining the breast tissue; examination of the axillary region may reveal lymph node involvement.
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