Please clarify whether a screening mammogram or a diagnostic mammogram should be performed on an asymptomatic patient with augmented breasts (e.g., breast implants).
According to the American College of Radiology’s Standard for Diagnostic Mammography, a diagnostic mammogram should be performed on patients with augmented breasts. However, the Centers for Medicare and Medicaid Service’s (CMS) payment policy for a diagnostic mammogram does not recognize asymptomatic patients with augmented breasts as diagnostic. Medicare will only pay for a screening mammogram for an asymptomatic woman with breast implants. Since Medicare denies the necessity of a diagnostic mammogram for an asymptomatic patient with augmented breasts, an advance beneficiary notice (ABN) should be obtained from the patient if the radiologist plans to bill the patient for a diagnostic mammogram. If the patient and referring physician decide that a screening mammogram should be performed, then the patient would receive a screening mammogram.
This question was answered in our Breast & Bone Density Procedure Coding Guide. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.