How To Use CPT Code 77065 | Unilateral Diagnostic Mammography With CAD

CPT 77065 is a diagnostic mammography code for unilateral breast imaging, including computer-aided detection (CAD) when performed. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 77065 procedures.

1. What is CPT 77065?

CPT 77065 is a medical billing code used for diagnostic mammography procedures performed on one breast, including the use of computer-aided detection (CAD) when applicable. This code is utilized by healthcare providers to accurately document and bill for the specific services provided during a unilateral diagnostic mammography.

2. 77065 CPT code description

The official description of CPT code 77065 is: “Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral.”

3. Procedure

The 77065 procedure involves the following steps:

1. The patient’s breast is positioned between two plates on the mammography machine.
2. The plates are pressed together firmly to compress the breast tissue.
3. An X-ray plate exposes the breast to radiation, capturing images of the breast tissue.
4. If necessary, computer-aided detection (CAD) software is used to analyze the images and identify potential abnormalities.
5. The healthcare provider reviews the images, taking note of any abnormalities detected by the CAD software.

4. Qualifying circumstances

Patients eligible to receive CPT code 77065 services are those who have a known lump or suspected cancer in one breast. This diagnostic mammography procedure is performed to help identify and diagnose potential abnormalities within the breast tissue. It is important to note that CPT 77065 is specifically for unilateral diagnostic mammography, meaning it is only used when imaging one breast.

5. When to use CPT code 77065

CPT code 77065 should be used when a healthcare provider performs a diagnostic mammography on one breast, with or without the use of computer-aided detection (CAD) software. This code is appropriate for patients with a known lump or suspected cancer in one breast, and when the provider aims to identify and diagnose potential abnormalities within the breast tissue.

6. Documentation requirements

To support a claim for CPT 77065, the following information should be documented:

• Patient’s medical history and reason for the diagnostic mammography
• Specific details of the procedure, including the use of CAD software if applicable
• Findings and interpretation of the mammography images
• Any recommendations for further testing or treatment based on the results

7. Billing guidelines

When billing for CPT code 77065, keep in mind the following guidelines and tips:

• For the same procedure on both breasts, report CPT 77066.
• For a bilateral procedure with two views from different angles, report CPT 77067.
• If reporting only the physician’s interpretation for the radiology service, append professional component modifier 26 to the radiology code.
• If reporting only the technical component for the radiology service, append modifier TC to the radiology code. Note that payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical.
• Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 77065 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Similar codes to CPT 77065

Five similar codes to CPT 77065 and how they differ are:

• CPT 77066: This code is used for diagnostic mammography on both breasts, including CAD when performed.
• CPT 77067: This code is used for screening mammography, bilateral, including CAD when performed.
• CPT 77063: This code is used for screening digital breast tomosynthesis, bilateral, in addition to the primary mammography service.
• CPT 77061: This code is used for diagnostic digital breast tomosynthesis, unilateral, including CAD when performed.
• CPT 77062: This code is used for diagnostic digital breast tomosynthesis, bilateral, including CAD when performed.

10. Examples

Here are 10 detailed examples of CPT code 77065 procedures:

1. A patient with a palpable lump in her left breast undergoes a diagnostic mammography with CAD on the left breast only.
2. A patient with a history of breast cancer in her right breast undergoes a diagnostic mammography with CAD on the right breast only as part of her follow-up care.
3. A patient with nipple discharge from her left breast undergoes a diagnostic mammography with CAD on the left breast only.
4. A patient with a suspicious finding on a screening mammogram in her right breast undergoes a diagnostic mammography with CAD on the right breast only for further evaluation.
5. A patient with a family history of breast cancer and a palpable lump in her left breast undergoes a diagnostic mammography with CAD on the left breast only.
6. A patient with a history of breast cancer in her left breast undergoes a diagnostic mammography without CAD on the left breast only as part of her follow-up care.
7. A patient with a suspicious finding on a screening mammogram in her left breast undergoes a diagnostic mammography without CAD on the left breast only for further evaluation.
8. A patient with a palpable lump in her right breast undergoes a diagnostic mammography without CAD on the right breast only.
9. A patient with nipple discharge from her right breast undergoes a diagnostic mammography without CAD on the right breast only.
10. A patient with a family history of breast cancer and a palpable lump in her right breast undergoes a diagnostic mammography without CAD on the right breast only.