How To Use CPT Code 77061

CPT 77061 is a diagnostic digital breast tomosynthesis procedure performed on one breast. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77061 procedures.

1. What is CPT 77061?

CPT 77061 is a diagnostic procedure that involves digital breast tomosynthesis on a single breast. This advanced imaging technique provides a three-dimensional view of the breast tissue, allowing for a more accurate and detailed examination. The procedure is used to detect and diagnose breast abnormalities, such as masses, calcifications, and architectural distortions.

2. 77061 CPT code description

The official description of CPT code 77061 is: “Diagnostic digital breast tomosynthesis; unilateral.”

3. Procedure

The 77061 procedure involves the following steps:

1. The patient is positioned and prepped for the examination.
2. The breast is compressed between a platform and paddle to immobilize and spread the tissue for better imaging.
3. An X-ray tube moves in an arc around the breast, capturing multiple images during a seven-second examination time.
4. The images are processed and reconstructed into a three-dimensional view of the breast tissue for analysis and interpretation by a radiologist.

4. Qualifying circumstances

Patients eligible to receive CPT 77061 services include those with:

• Signs or symptoms of breast abnormalities, such as a palpable mass, nipple discharge, or skin changes.
• Abnormal findings on a screening mammogram that require further evaluation.
• A personal history of breast cancer or other high-risk factors, such as a strong family history or genetic predisposition.
• A recommendation from a healthcare provider for diagnostic breast imaging due to clinical concerns.

5. When to use CPT code 77061

It is appropriate to bill the 77061 CPT code when a diagnostic digital breast tomosynthesis is performed on one breast for the purpose of detecting and diagnosing breast abnormalities. This code should be used when the procedure is medically necessary and supported by the patient’s clinical history and documentation.

6. Documentation requirements

To support a claim for CPT 77061, the following information should be documented:

• Patient’s demographic information, including age, gender, and relevant medical history.
• Indication for the procedure, such as signs or symptoms of breast abnormalities, abnormal screening mammogram findings, or high-risk factors.
• Details of the procedure, including the date, time, and location of the examination.
• Technical aspects of the examination, such as the type of equipment used and the number of images obtained.
• Radiologist’s interpretation of the images, including any findings, impressions, and recommendations for further evaluation or management.

7. Billing guidelines

When billing for CPT code 77061, keep in mind the following guidelines and tips:

• Use CPT code 77062 for diagnostic digital breast tomosynthesis performed on both breasts.
• For screening services, use CPT code +77063 for bilateral screening digital breast tomosynthesis.
• Append modifier 26 to the radiology code when reporting only the physician’s interpretation of the service.
• Append modifier TC to the radiology code when reporting only the technical component of the service. Note that some payer policies may exempt hospitals from using modifier TC.
• Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 77061 was added to the Current Procedural Terminology system on January 1, 2015. The code was changed on January 1, 2019, with the previous descriptor being “Digital breast tomosynthesis; unilateral.”

9. Similar codes to CPT 77061

Five similar codes to CPT 77061 and how they differ are:

• CPT 77062: This code is used for diagnostic digital breast tomosynthesis performed on both breasts, rather than just one.
• +77063: This add-on code is used for bilateral screening digital breast tomosynthesis, which is a preventive service rather than a diagnostic one.
• CPT 77065: This code is for diagnostic mammography, including tomosynthesis, performed on one breast.
• CPT 77066: This code is for diagnostic mammography, including tomosynthesis, performed on both breasts.
• CPT 77067: This code is for screening mammography, including tomosynthesis, performed on both breasts as a preventive service.

10. Examples

Here are 10 detailed examples of CPT code 77061 procedures:

1. A 45-year-old woman with a palpable mass in her left breast undergoes diagnostic digital breast tomosynthesis of the left breast.
2. A 50-year-old woman with a family history of breast cancer has an abnormal finding on her screening mammogram and undergoes diagnostic digital breast tomosynthesis of the right breast for further evaluation.
3. A 55-year-old woman with a history of breast cancer in her left breast presents with new nipple discharge from the same breast and undergoes diagnostic digital breast tomosynthesis of the left breast.
4. A 60-year-old woman with a genetic predisposition for breast cancer has an inconclusive screening mammogram and undergoes diagnostic digital breast tomosynthesis of the right breast for further assessment.
5. A 65-year-old woman with a history of breast cancer in her right breast presents with new skin changes on the same breast and undergoes diagnostic digital breast tomosynthesis of the right breast.
6. A 70-year-old woman with a strong family history of breast cancer has an abnormal finding on her screening mammogram and undergoes diagnostic digital breast tomosynthesis of the left breast for further evaluation.
7. A 75-year-old woman with a history of breast cancer in her left breast presents with new breast pain in the same breast and undergoes diagnostic digital breast tomosynthesis of the left breast.
8. An 80-year-old woman with a genetic predisposition for breast cancer has an inconclusive screening mammogram and undergoes diagnostic digital breast tomosynthesis of the left breast for further assessment.
9. A 40-year-old woman with a family history of breast cancer has an abnormal finding on her screening mammogram and undergoes diagnostic digital breast tomosynthesis of the right breast for further evaluation.
10. A 35-year-old woman with a history of breast cancer in her right breast presents with new breast pain in the same breast and undergoes diagnostic digital breast tomosynthesis of the right breast.