77063

Diagnostic mammography, unilateral

Diagnostic mammography, unilateral, is a detailed radiological examination of a single breast using low-dose X-rays to investigate a specific breast complaint or to further evaluate an abnormal finding detected on a screening mammogram or clinical breast exam. This procedure involves obtaining multiple views (e.g., craniocaudal (CC), mediolateral oblique (MLO), true lateral) and potentially specialized imaging techniques (e.g., magnification, spot compression views) of one breast. Its purpose is to thoroughly assess suspicious areas such as masses, calcifications, architectural distortion, or skin changes. This procedure is distinct from screening mammography, which is performed in asymptomatic individuals.

Clinical Indications

  • Evaluation of a new or persistent palpable breast lump or mass in one breast.
  • Investigation of localized or persistent breast pain in one breast.
  • Assessment of unilateral nipple discharge (especially if spontaneous or bloody).
  • Evaluation of skin changes (e.g., dimpling, thickening, redness, edema) affecting one breast.
  • Further workup of an abnormal finding on a screening mammogram (e.g., new mass, suspicious calcifications, architectural distortion) in one breast.
  • Follow-up of previously identified benign breast findings or post-surgical changes in a specific area of one breast.
  • Problem-focused evaluation for signs or symptoms of recurrence in a breast with a history of cancer.

Procedure Steps

  1. Patient removes clothing from the waist up and dons a gown; technologist explains the procedure.
  2. The patient is positioned for various views (e.g., craniocaudal, mediolateral oblique, true lateral) of the single breast being examined.
  3. The breast is compressed between two plates to flatten the tissue, reduce radiation dose, and improve image quality by spreading out overlapping tissues.
  4. X-ray images are acquired from different angles as needed.
  5. If necessary, additional specialized views such as magnification views (to evaluate microcalcifications) or spot compression views (to better characterize masses or architectural distortion) may be obtained for the affected breast.
  6. Images are reviewed by the technologist for technical quality.
  7. A radiologist reviews and interprets the images, dictating findings and recommendations.

Coding Guidelines

  • **CPT 2024 Deletion**: CPT code 77063, 'Diagnostic mammography, unilateral,' was **deleted** effective January 1, 2024, and is no longer valid for services rendered on or after this date.
  • **Replacement Codes (for Unilateral Diagnostic Mammography)**: For services on or after January 1, 2024, reporting for unilateral diagnostic mammography has changed:
  • - For **unilateral diagnostic mammography without digital breast tomosynthesis (DBT)**, report the new CPT code **7D0621**.
  • - For **unilateral diagnostic mammography with digital breast tomosynthesis (DBT)**, report the new CPT code **7D0622**.
  • **Diagnostic vs. Screening**: This code (and its replacement codes) is for *diagnostic* mammography, performed when there is a specific breast concern or an abnormal finding requiring further evaluation. It is distinct from routine *screening* mammography.
  • **Computer-Aided Detection (CAD)**: If Computer-Aided Detection (CAD) is performed for diagnostic mammography (now utilizing 7D0621 or 7D0622), report add-on code +77066 (Computer-aided detection (CAD) for diagnostic mammography, with further physician review for interpretation, bilateral or unilateral).
  • **Documentation**: Medical necessity for a diagnostic study must be clearly documented in the patient's medical record, including the specific symptoms, abnormal clinical findings, or abnormal prior imaging results that prompted the examination.

Associated ICD-10 Codes