Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

Coverage for diagnostic mammography, breast sonography, breast MRI, and ductography requires a clear clinical indication documented in the medical record and appropriate referral/order documentation; diagnostic studies converted from screening are allowed if the screening abnormality is documented. Claims must include a valid ICD-10-CM diagnosis code, the ordering/referring provider name and NPI when required, and specific documentation elements (signed reports, interpretation, recipient physician); ABN and modifier rules (GA, GX, GZ, GY, GG) and NCCI/OPPS billing edits must be followed.

"Diagnostic mammography, breast sonography (echography), breast MRI, and ductography are covered when a clear clinical indication for the test is documented in the medical record and in the referral..."

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