May is Women’s Health Month, a time to recognize and explore the impact of the many significant health issues women face every day. Mammography remains a critical area of women’s healthcare, influencing lives through preventive screenings, early detection, and follow-up care needs identified through mammography services. However, ongoing challenges continue to create significant risks for providers and organizations alike. Our nationally renowned subject matter experts have identified common FAQs based on the challenges healthcare professionals encounter each year across the country. By understanding these foundational and widespread issues, professionals can better overcome obstacles and position themselves for success in 2026.
Q. If a physical exam is performed in conjunction with a diagnostic mammogram or breast ultrasound and the results are discussed with the patient, is it appropriate to bill for an office visit, such as 99212, if performed in a private office setting?
A. It is only appropriate to bill for a consultation or other evaluation and management (E&M) service when the service is provided and documented according to established E&M guidelines. For breast interventional procedures, a brief review of history and physical exam and obtaining informed consent is not a separately reportable E&M service. This service is considered bundled into the surgical procedure code.
Q. We did a bilateral diagnostic mammogram on a patient and because of the findings decided to perform an ultrasound guided breast biopsy on the same day. A unilateral mammogram was done after the biopsy to verify clip placement. Can we code both of the mammograms?
A. Currently, a national correct coding initiative (NCCI) edit precludes billing both a bilateral and a unilateral mammogram on the same day. The edit has a “0” indicator, so it cannot be bypassed with a modifier. Since there is no limit to the number of views required for a bilateral diagnostic mammogram, all diagnostic images taken on the same day are considered to be included in the more comprehensive service (i.e., CPT 77066).
Q. Do we need to report CPT® add-on code +77063 with modifier 52 when reporting it with 77067-52 during the same encounter?
A. Yes. Both +77063 and 77067 are bilateral codes, so if a unilateral screening mammogram is performed with a unilateral screening tomosynthesis, modifier 52 should be appended to both CPT codes to indicate the reduced nature of the services.
Q. Is breast tomosynthesis considered a three-dimensional (3D) study?
A. While vendors and the lay press often describe breast tomosynthesis as “three-dimensional” (3D), for coding purposes, breast tomosynthesis is not a 3D study. For this reason, the American College of Radiology (ACR) collaborated with the Current Procedural Terminology (CPT) Editorial Panel and Relative Value Scale Unit Update Committee to discourage the use of the terms “2D” and “3D.” In practice, breast tomosynthesis is similar to acquiring tomographic images during conventional tomography (eg, intravenous pyelogram) and viewing the individual tomographic images in a stacked set. Therefore, this is not a 3D study for the purposes of CPT coding.
Q. If we perform a bone density on the hips and forearm can we bill both CPT code 77080 and 77081 together?
A. Yes, in 2020, the American Medical Association (AMA) and the American College of Radiology (ACR) changed their policy on this, and CMS followed suit soon after with Transmittal 10193, which was effective July 1, 2020, allows for modifier XU to bypass Common Working File (CWF) edits when 77080 and 77081 are reported together on the same claim. However, although the 2025 NCCI edit file version 31.3 allows for the reporting of both appendicular (peripheral) and axial (central) studies if performed at separate encounters or under other unusual non-overlapping circumstances with a modifier indicator of “1,” Chapter 9, Section H, #15 of the 2025 NCCI Policy Manual guidance still precludes this. Check with your MAC or watch for updated LCDs or policy manual guidance for clarification.
With reimbursement pressures rising and regulatory complexity continuing to evolve, accurate CPT® coding and compliant documentation are more critical than ever. Gain the expert guidance you need to confidently navigate coding challenges impacting women’s health services in 2026.
Strengthen your coding accuracy and reduce compliance risk with these expert-led educational webcasts designed to simplify complex coding scenarios and improve reimbursement outcomes:
These essential training opportunities are designed for both audio and visual learners, delivering actionable coding guidance, compliance strategies, and real-world insight from nationally recognized subject matter experts.
Let’s admit it: the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) official conventions, guidelines, and advice involving sepsis and its consequences have been
The Centers for Medicare & Medicaid Services (CMS) is continuing its multi-year push toward payment accuracy, documentation integrity, and value-based care. While the most visible
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
