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Correct Coding Reminder for Breast Imaging

When there are no abnormal and inconclusive findings on mammography and the only finding is dense breast tissue (ICD-10-CM codes R92.30-R92.34), the provision of an ultrasound is considered screening. Since Medicare does not have a covered benefit for screening breast ultrasound, claims will be denied.

Effective 10/1/2023, the descriptor of ICD-10 code R92.2 (inconclusive mammogram) was revised to no longer include dense breasts NOS. ICD-10 code R92.2 will be considered incorrect coding when reporting dense breasts and therefore not covered.

For coverage provisions related to breast imaging, please refer to LCD L33585, Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography and the related Billing and Coding article, A52849.

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Posted 1/4/2024