How To Use HCPCS Code G0279

HCPCS code G0279 describes the diagnostic digital breast tomosynthesis procedure, which is used for the detection and diagnosis of breast cancer. This code is used to identify the unilateral or bilateral tomosynthesis performed in addition to the standard mammography procedures (HCPCS codes 77065 or 77066).

1. What is HCPCS G0279?

HCPCS code G0279 is a specific code used to identify the diagnostic digital breast tomosynthesis procedure. It is important to note that this code should be used in addition to the standard mammography codes (77065 or 77066) when tomosynthesis is performed.

2. Official Description

The official description of HCPCS code G0279 is “Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)”. The short description for this code is “Tomosynthesis, mammo”.

3. Procedure

1. The provider positions the patient in front of the digital breast tomosynthesis machine.
2. The breast is compressed between two plates to ensure clear images.
3. The machine takes multiple low-dose X-ray images of the breast from different angles.
4. The images are reconstructed into a three-dimensional representation of the breast tissue.
5. The radiologist reviews the images to detect any abnormalities or signs of breast cancer.

4. When to use HCPCS code G0279

HCPCS code G0279 should be used when the provider performs diagnostic digital breast tomosynthesis in addition to the standard mammography procedures (HCPCS codes 77065 or 77066). It is important to use this code only when tomosynthesis is performed, as it is an additional service provided.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0279, healthcare providers need to document the performance of diagnostic digital breast tomosynthesis in addition to the standard mammography procedures. This documentation should include the indication for the tomosynthesis, the number of views taken, and any findings or abnormalities detected during the procedure.

6. Historical Information and Code Maintenance

HCPCS code G0279 was added to the Healthcare Common Procedure Coding System on January 1, 2015. As of January 1, 2018, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the diagnostic digital breast tomosynthesis procedure when performed in addition to the standard mammography procedures. The pricing indicator code for HCPCS code G0279 is 13, which means the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0279 should be billed:

1. A patient undergoes a routine mammogram, and the radiologist determines that additional tomosynthesis is necessary to further evaluate a suspicious area.
2. A patient with a family history of breast cancer undergoes a screening mammogram, and the provider decides to perform tomosynthesis to obtain a more detailed view of the breast tissue.
3. A patient presents with a palpable lump in the breast, and the provider orders a diagnostic mammogram with tomosynthesis to evaluate the lump and surrounding tissue.
4. A patient with a history of breast cancer undergoes a follow-up mammogram, and the provider performs tomosynthesis to assess for any recurrence or new abnormalities.
5. A patient with dense breast tissue undergoes a screening mammogram, and the provider decides to perform tomosynthesis to improve the detection of potential abnormalities.