Health Information Management

Charge diagnostic mammogram for patient with history of cancer

APCs Insider, July 1, 2005

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Charge diagnostic mammogram for patient with history of cancer

QUESTION: When a non-symptomatic mammography patient has a previous history of breast cancer, do you charge the patient for a screening mammogram or a diagnostic mammogram?

ANSWER: The term "screening mammography" means a radiological procedure provided to an asymptomatic woman for the purpose of early detection of breast cancer. The definition includes a physician's interpretation of the results. Unlike diagnostic mammographies, the exam is covered even if there are no signs, symptoms, or history of breast disease.

A diagnostic mammogram is a covered service under the following conditions:

     A patient has distinct signs and symptoms for which a mammogram is indicated;

     A patient has a history of breast cancer; or

     A patient is asymptomatic, but on the basis of the patient's history and other factors the physician considers significant, the physician's judgment is that a mammogram is appropriate

Because the patient you described has a history of breast cancer, it appears that you should bill for a diagnostic mammogram.



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