Diagnosis Codes and Reporting

Recommended Diagnosis Codes for Mammography and Ultrasound

Preventive:

Z12.3, N95.1, Z80.3, Z87.7, Z91.8 , N60.0 - N60.9, N64.0 - N64.4

Diagnostic:

N63, N61, C50, D486, N645

Entitlement to Preventive (Screening) Mammography Covered by Health Insurance Is Granted to Every Woman If She Meets These Conditions:

– asymptomatic
– older than 45 years old
– more than two years have passed since the last screening mammography (the exact interval is monitored by the health insurance company)
– a referral from a gynaecologist or general practitioner

Screening mammography is not included in the doctor's induced care, including an additional ultrasound and now a core-cut biopsy.
If a woman does not meet the above conditions, she can still have a preventive mammogram for a fee (see price list). The condition is being over 40 years old (except for examinations before cosmetic surgery) and the last mammogram was more than a year ago. This paid examination is most often recommended for women in the interim period between two screening mammograms while on HRT (Hormone Replacement Therapy).
Individual preventive ultrasound breast examination is not covered by health insurance, but it can be performed on a direct payment basis by the client (see price list). This examination is not age-restricted.

Diagnostic mammography and diagnostic ultrasound are indicated in symptomatic patients (both women and men). These include the patients of all ages. They may have one of the following symptoms: palpable tumor or resistance, bloody nipple discharge, nipple retraction, skin dimpling, lump, eczema on the nipple, or other clinical signs of breast disease. This examination falls under physician-induced care. Proper selection of the numerical diagnosis code on the referral form is important for diagnostic examination (see above).
The radiologist is responsible for the effectiveness of the examination, i.e. he/she selects the imaging method of first choice (mammography or ultrasound) and the subsequent examination procedure. If it is appropriate to perform a biopsy after a diagnostic mammography, unlike a screening mammography, we cannot indicate this examination ourselves. You may therefore be asked to obtain a referral form for this examination. Please cooperate, our doctors ask for this examination in completely justified cases.

If it is clear from the referral form and from all other information available to the screening centre radiologist (including, for example, the woman's medical history) that this is a preventive mammography examination and not a diagnostic mammography, the radiologist may change the diagnosis and justify in the description why the type of examination was changed from diagnostic to preventive.
The situation can, of course, be the opposite – in justified cases, changing from a preventive mammogram to a diagnostic one.

Correct Reporting

Mammography

Preventive Mammography – (dg. Z12.3, N60.0 to N60.9, N62, N64.0 to N64.4, D24, N95.1, N95.9)

Any woman who meets the following conditions is entitled to a preventive (screening) mammography covered by health insurance:

• Asymptomatic
• reaching the age of 45
• at least two years have passed since the last screening MG (health insurance companies monitor the interval to the day)
• a referral from a general practitioner or gynaecologist

Female clients of the OZP insurance company can take advantage of a special program of their insurance company and undergo a preventive mammogram free of charge once every two years from the age of 40. In the 40-44 age group, a referral from a doctor is not required for a preventive mammogram. After the age of 45, it is already a routine screening mammography and a referral for an examination is required, just like for clients of other health insurance companies.

– Screening mammography is not included in the referring physician's induced careincluding additional ultrasound examination and core cut biopsy.

Diagnostic Mammography – ( dg. C50, N61, N63, N64.5, D05.1, D48.6)

Diagnostic mammography is indicated for symptomatic patients. Mammography is performed for both female and male patients. It is conducted after reaching the age of 40, provided it hasn't been done within the past year (for oncology patients, it can be done more frequently). Mammography can also be performed at a younger age for significant diagnostic reasons, with the examination's indication determined by the radiologist.

Symptoms for diagnostic mammography are: palpable resistance in the breast, bloody secretion from the nipple, skin changes on the nipple and other clinical signs of breast disease.

Therefore, in order for the diagnostic examination to be covered by health insurance, it is necessary that the client has a referral with the correct diagnosis and/or described clinical problems. This examination goes to the induced care of the referring physician.

Ultrasound Scan

Ultrasound examination is performed in women under 40 years of age (preventive and diagnostic) or as an adjunct to mammography. Ultrasound prevention is currently not covered by any health insurance company in any age group. Clients can pay for ultrasound prevention themselves according to the current price list, in which case no referral is required. Likewise, women in the age group over 45 can pay for their own ultrasound screening in between screening mammograms. Mammography and ultrasound are adjunctive, not substitute, screening methods - unless a woman of screening age does not wish to have a screening mammogram for personal reasons, she cannot have a preventive ultrasound covered by health insurance instead.

Diagnostic ultrasound covered by the health insurance can be performed on women and men of all ages on the basis of a correct diagnosis and/or clinical problems listed on the referral (palpable resistance in the breast, bloody secretion from the nipple, skin changes on the nipple and other clinical signs of breast disease) – (diagnoses C50, N63, N61, D48.6, N64.5, D05.1).

The radiologist is responsible for the effectiveness of the examination, meaning they choose the primary imaging method (mammography or ultrasound) and the subsequent diagnostic procedure.

If it is clear from the referral form and from all other information available to the screening centre radiologist (including, for example, the woman's medical history) that this is a preventive mammography examination and not a diagnostic mammography, the radiologist may change the diagnosis and justify in the description why the type of examination was changed from diagnostic to preventive.
The situation can, of course, be the opposite – in justified cases, changing from a preventive mammogram to a diagnostic one.

Need to know more? You can read the following article on correct reporting.