Coding for bilateral screening mammography and tomosynthesis

Q.

Does CPT^® code 77063 need a -52 modifier when submitted with CPT code 77067 – 52? Medicare is reimbursing for CPT codes 77067-52 and 77063 (no modifier).

A.

Both CPT code 77063 and 77067 state “bilateral”, so if you do a unilateral screening mammogram with a unilateral screening tomosynthesis, you should add modifier 52 to both CPT codes.

If you assign CPT code 77067–52 with 77063 (no modifier) you are telling the payer that you did a unilateral screening mammogram with a bilateral screening tomosynthesis. Medicare will trust that you have coded and billed compliantly until they were to audit you.

The codes and complete descriptions are as follows:

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