As mentioned in a previous blog, mammography coding updates have already been a significant topic of discussion since the beginning of the calendar year. Unfortunately, these updates caused a number of new coding issues, meaning that the Centers for Medicare and Medicaid Services (CMS) had no choice but to release an additional update.

On January 1st, CMS replaces the HCPCS codes for screening and diagnostic mammographies with permanent CPT codes. However, this update also accidentally changed the type of service (TOS) code from 1 (Medical care) to 4 (Diagnostic radiology). Though seemingly minor, this alteration meant that providers and suppliers could no longer bill CPT 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed) without referring physician information being present on the claim.

Thankfully, CMS has already addressed the issue with additional mammography coding updates that will go into effect on July 2nd. This correction will switch the TOS code back to 1, meaning that the lack of referring information will no longer be a problem. In addition, the company has instructed its local Medicare administrative contractors (MACs) to automatically reprocess any 77067 claims billed between January 1st, 2018 and July 2nd, 2018 in hopes of minimizing the impact of the error.

If you work for a practice or facility that bills a high number of mammography codes, it is worth double-checking your claims to see how this update has affected them. If you discover any claims that were incorrectly processed or denied due to the type of service mix-up, be sure to contact your MAC as soon as possible in order to get the issue sorted out. Mammography coding updates will continue to appear in the future, so it is essential to be prepared for any new changes CMS may enact both this year and in years to come.