General Question for the Week of August 3, 2020

Question:

We have a referring physician that insists on ordering a unilateral screening mammogram on the same script as a unilateral diagnostic mammogram. Can you please advise as to the correctness of this order?

Answer:

No, that is not a valid order. If a patient has a need for a diagnostic mammogram, then she does not qualify for a screening. The doctor can order a unilateral diagnostic mammogram and go back to screening whenever the patient has been cleared of cancer or other breast diseases. A screening mammogram is an exam for a woman without signs or symptoms of breast disease, for the purpose of early detection of breast cancer. ACR stated the following in the ACR Coding Source, May, June 2013: “Therefore, whenever a diagnostic study is indicated, it is appropriate to do a diagnostic mammogram on one or both breasts as indicated. It is not appropriate to do a screen of one breast and a diagnostic of the other. … If a patient presents for their annual screen and a breast lump is felt, that is an indication for a bilateral diagnostic study. For biopsy-proven benign breast disease, a diagnostic or screening study may be performed. CMS expanded its definition of diagnostic mammography to include a personal history of biopsy-proven benign breast disease, thereby allowing the attending physician and the patient the opportunity to determine whether a screening mammogram or a diagnostic mammogram is performed.”