How To Use CPT Code 77063

CPT 77063 is a code for screening digital breast tomosynthesis, a procedure that captures three-dimensional images of the breast for routine checkups. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77063.

1. What is CPT 77063?

CPT 77063 is a medical billing code used for screening digital breast tomosynthesis, a diagnostic imaging procedure that captures three-dimensional images of the breast using X-rays at various angles. This procedure is performed for routine checkups to detect any abnormalities within the breasts. Tomosynthesis provides more accurate imaging than conventional mammography, allowing for better detection of breast cancer and other breast-related issues.

2. 77063 CPT code description

The official description of CPT code 77063 is: “Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)”.

3. Procedure

The 77063 procedure involves the following steps:

1. The patient is positioned comfortably, either standing or sitting, with their breast placed between two glass plates.
2. The provider compresses and holds the breast between the plates, applying slight pressure to stabilize the breast in a specific position.
3. An X-ray tube moves in an arc around the breast, capturing multiple images at various angles.
4. The X-ray machine sends the images to a computer for analysis.
5. The computer processes the images and displays the results, providing a three-dimensional view of the breast for the provider to examine.

4. Qualifying circumstances

Patients eligible to receive CPT code 77063 services are typically women who meet the following criteria:

• Age 40 or older
• No current symptoms or signs of breast cancer
• Not pregnant or breastfeeding
• No personal history of breast cancer or high-risk factors for breast cancer
• Have not had a mammogram within the past 12 months

It is important to note that individual insurance plans may have additional criteria for coverage of this service.

5. When to use CPT code 77063

CPT code 77063 should be used when billing for screening digital breast tomosynthesis as part of a routine checkup for patients who meet the qualifying circumstances listed above. This code is used in conjunction with the primary procedure code for mammography (CPT 77067) and should not be reported with codes 76376, 76377, 77065, or 77066.

6. Documentation requirements

To support a claim for CPT 77063, the following information should be documented:

• Patient demographics, including age and gender
• Relevant medical history, including any personal or family history of breast cancer or high-risk factors
• Date of the last mammogram, if applicable
• Indication for the procedure (i.e., routine screening)
• Details of the procedure, including the type of equipment used and the number of images captured
• Findings and interpretation of the images by the provider
• Any recommendations for follow-up or additional testing, if necessary

7. Billing guidelines

When billing for CPT code 77063, it is important to follow the appropriate guidelines and rules. This code should be listed separately in addition to the primary procedure code for mammography (CPT 77067). It should not be reported with codes 76376, 76377, 77065, or 77066. Additionally, ensure that all documentation requirements are met to support the claim and avoid potential denials or delays in payment.

8. Historical information

CPT 77063 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 77063

Five similar codes to CPT 77063 and how they differ are:

1. CPT 77065: Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral. This code is used for diagnostic mammography of one breast.
2. CPT 77066: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral. This code is used for diagnostic mammography of both breasts.
3. CPT 77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed. This code is used for routine screening mammography of both breasts.
4. CPT 76376: 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality. This code is used for 3D rendering of images from various imaging modalities, not specific to breast imaging.
5. CPT 76377: 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image post-processing on an independent workstation. This code is similar to CPT 76376 but requires additional post-processing on a separate workstation.

10. Examples

Here are 10 detailed examples of CPT code 77063 procedures:

1. A 45-year-old woman with no personal or family history of breast cancer undergoes a routine screening digital breast tomosynthesis as part of her annual checkup.
2. A 50-year-old woman with a history of benign breast cysts undergoes a screening digital breast tomosynthesis to monitor for any changes in her breast tissue.
3. A 55-year-old woman who has not had a mammogram in the past two years undergoes a screening digital breast tomosynthesis as part of her routine checkup.
4. A 60-year-old woman with a family history of breast cancer undergoes a screening digital breast tomosynthesis to monitor for early signs of breast cancer.
5. A 65-year-old woman with no history of breast cancer undergoes a screening digital breast tomosynthesis as part of her annual checkup.
6. A 70-year-old woman with a history of hormone replacement therapy undergoes a screening digital breast tomosynthesis to monitor for any changes in her breast tissue.
7. A 75-year-old woman with a history of breast cancer in her sister undergoes a screening digital breast tomosynthesis to monitor for early signs of breast cancer.
8. A 40-year-old woman with no personal or family history of breast cancer undergoes a screening digital breast tomosynthesis as part of her first routine checkup after turning 40.
9. A 48-year-old woman with a history of dense breast tissue undergoes a screening digital breast tomosynthesis to monitor for any changes in her breast tissue.
10. A 52-year-old woman with a family history of breast cancer undergoes a screening digital breast tomosynthesis as part of her annual checkup.