October is Breast Cancer Awareness Month. The American Cancer Society reports that there will be an estimated 310,720 women and 2,800 men diagnosed with invasive breast cancer in 2024. As disheartening as this statistic might be, there is hope. By screening for this disease regularly, you have a better chance of catching it early. According to another report, catching breast cancer in its early and localized stages boosts the 5-year relative survival rate to 99%.
With continued advancements in early detection, coupled with the movement to spread awareness worldwide, our society continues to increase breast cancer survival rates. In fact, there are more than 4 million breast cancer survivors in the United States today.
To screen for breast cancer, doctors use an X-ray imaging method called a mammography. Billing and coding for these mammography services can be difficult to navigate. Especially when it comes down to understanding the different Current Procedural Terminology (CPT) codes. Today, we will cover different mammography CPT codes. As well as any best practices to keep in mind when billing for these life-saving services.
Table of Contents
What is a CPT Code?
If you have been keeping up with us and our blogs for a while, you might have seen mention of “CPT codes” before. If you’ve never heard of them, or simply need a refresher on what exactly they are, keep reading.
Current Procedural Terminology codes, otherwise known as CPT codes, are vital when it comes to being able to process claims. It is a coding system that consists not only of terms but of identifying codes as well. Medicaid, Medicare, and all other healthcare programs accept and function under this universally accepted medical vocabulary.
Understanding when to use these codes can mean the difference between having a smooth revenue cycle and having high denial rates. The more claim denials your company sees, the less revenue that gets collected.
Types of CPT Codes
There is more than only one kind of CPT code. What they all have in common though is that they are all 5 characters long. CPT codes can be numeric or alphanumeric. This all depends on what service the healthcare professional provides. Most medical coders will work with Category I CPT codes. These are the main codes that describe medical procedures and services based on these 6 different sections:
Radiology
Pathology and Laboratory
Medicine
Anesthesiology
Evaluation and Management
Surgery
Category II CPT codes are more supplemental. Known as tracking codes, or performance measurement codes, they collect data in relation to quality. These codes contain 4 digits and end with the letter F. They are not specifically required for billing, but helpful to refer to for future patient management.
Category III CPT codes are temporary tracking codes used for new medical technologies and procedures. Separating these into their category helps with the data collection and assessment of these new procedures. If widely accepted, these become Category I CPT codes.
Mammography CPT Codes
Now that you know what a CPT code is and why they are essential to medical billing, let’s talk specifically about mammography CPT codes. As I said before, emphasizing regular screening for breast cancer is vital in the fight against it. Therefore, it is important to note that screening CPT codes are going to be different from diagnostic CPT codes.
Healthcare providers perform screenings on otherwise healthy individuals to look for signs or precursors of cancer. Whereas diagnostic mammography includes additional x-ray views of both breasts. These take place at different angles as well, with additional imaging techniques, offering better visualization of any abnormalities. These two different procedures must align with specific CPT codes to bill correctly.
Here are a few examples of mammography CPT codes that providers use for screening:
77063: Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure).
77067: Screening mammography, bilateral (2-view study of each breast), including Computer-Aided Detection (CAD) when performed; bilateral.
Here are some examples of mammography CPT codes that providers use for diagnosing:
77065: Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.
77066: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral.
Of course, these are not all of the CPT codes for mammography services. They are some of the more common ones, which tend to get mixed up with one another, causing errors in medical billing. Remember to pay close attention to what you are billing to avoid claim denials and long waits on revenue collection.
Breast Cancer Awareness Statistics and Facts
Breast cancer death rates have thankfully been decreasing as time goes on. From 1989 to 2021, we have seen an overall decline in the number by 41%. This is due to the result of finding breast cancer sooner, thanks to those who are raising awareness. Increased screening and awareness of this disease are helping victims and their families fight back.
So let’s go over some key statistics and facts about breast cancer, and why it is so important to spread awareness:
Breast cancer is the most common cancer for women in the United States.
Breast cancer accounts for 30% of all new female cancer diagnoses each year.
The median age diagnosis of breast cancer patients is 62. There is a very small number of patients diagnosed younger than 45.
In the United States, the average risk of a woman developing breast cancer in her life is about 13%.
After lung cancer, breast cancer is the second leading cause of cancer death in women.
Breast cancer risk nearly doubles when the patient has a first-degree relative who had a previous diagnosis. 15% of women diagnosed with breast cancer have a family member also diagnosed with it.
Gene mutations account for about 5% to 10% of breast cancers. These involve mutations in the BRCA1 and BRCA2 genes. Those with a BRCA1 mutation may have up to a 72% chance of developing breast cancer, while BRCA2 mutations have up to a 69% risk. These cancers tend to develop in younger women.
Breast cancer is not specific to women. Men with BRCA2 mutations have a lifetime risk of developing breast cancer of almost 7%.
Around 85% of breast cancers occur in women who have no family history of breast cancer, or inherited mutations. These cancers are due to mutations that happen as a result of aging and other factors of life.
Conclusion
With advancements in medicine and technology, as well as the added benefit of raising awareness, breast cancer survival rates are improving. Early detection from regular screenings through techniques, such as using mammography, proves to be a vital tool.
Both healthcare providers and patients rely on accurate billing and coding habits to ensure seamless care. Mistakes in billing can lead to the loss of large amounts of money due to claim delays and denials. For a healthy revenue cycle, it is imperative to keep your team up to date on all medical billing and coding industry updates as they can change yearly. Especially with the influence of evolving medical technology.
Emphasize the difference between screening and diagnostic CPT codes. Doing so helps to ensure accurate coding which helps to avoid frustrations of claim denials, but also accelerates your reimbursements. Helping you get paid while reducing company-wide administrative burden. This way, your staff can focus more on providing quality care to your patients.
It also provides more patient satisfaction when providers correctly submit claims the first time. This means reduced financial surprises. Understanding CPT codes of any kind helps reduce denials, streamlines your revenue cycle, and builds patient relationships.
