Understanding CPT Code 77067: A Radiology Billing Deep Dive

Radiology billing has many codes, and some are simple, while others are actually complex to manage. One of the difficult codes you often need to handle in your billing process is CPT code 77067. Most amateur coders consider it as just a simple mammogram code, but in reality, it goes far beyond that. You need to use this code when you have performed screening mammography as part of a routine breast cancer check-up, particularly when your patient demonstrates no symptoms.

CPT 77067 is used when both breasts are screened with two views each, and CAD is included if done. It's only for routine screenings with no symptoms. If the patient has a lump, pain, or other issues, use codes like 77065 or 77066. Using the wrong code can cause billing problems and payment delays.

Now, you might be wondering about the reasons that make 77067 really unique, right? Well, things that make it really exclusive are mentioned below.

Things that make CPT 77067 unique in radiology billing service:

CPT 77067 stands out in radiology billing for a few key reasons. First, it includes CAD (computer-aided detection), so you don't need to bill it separately—doing so may lead to denials. Second, it's only for bilateral mammograms, meaning both breasts must be screened. If just one breast is checked, this code doesn't apply. Third, you can only use this particular code for patients with no symptoms. If the patient has pain, a lump, or any concern, it becomes a diagnostic case and needs a different code. Finally, Medicare has special rules for CPT 77067. The good news is that it usually covers one screening every 12 months for women over 40. You must use the correct modifier when needed—-TC for the technical part, -26 for the professional part, or bill globally if both are included. Be careful not to bill too early, or the claim might get denied.

Not everyone can bill CPT 77067. You must be a licensed provider or facility with the right credentials. The mammography equipment must be FDA-certified. You also need to follow MQSA (Mammography Quality Standards Act) rules. If these steps aren't followed, it can lead to compliance problems. Using the wrong code for CPT 77067 can hurt your business. Denials delay payments. Fixing errors takes up staff time.

If you handle radiology billing services, following best practices for CPT 77067 helps avoid denials and delays.

• Train your front-desk team:

Make sure your front-end team always knows what to ask your patients, as they should always confirm if the visit is for a routine screening or if the patient shows up with any symptoms. Providing your team with this particular training session always helps them stay away from the wrong coding practice.

• Use a screening questionnaire:

Give patients a short form to fill out before the exam. It should clearly confirm they have no symptoms. This written proof is helpful during audits or claim reviews.

• Double-check diagnosis codes:

Always use a valid screening diagnosis like Z12.31. Check it carefully before billing. The wrong diagnosis code can turn a clean claim into a denial or delay.

• Avoid duplicate billing:

Never bill separately for CAD or interpretation when it's already part of CPT 77067. Doing so can lead to claim rejections for duplicate services or overbilling.

• Check insurance rules:

Never forget the fact that Medicare allows one screening in a year for women aged more than 40 years. But private payers may have different timelines. Always verify coverage to avoid billing too soon.

• Review denials quickly:

If a claim is denied, don't delay. Find the reason, correct the issue, and resubmit fast. You can always recover your payments quickly and keep your cash flow strong by taking quick action.

You might have already realized that handling CPT 77067 is not as easy as it may sound. It always requires careful attention to detail. A single mistake in your billing process can lead your radiology practice to face serious issues like claim denials, audits and poor revenue infrastructure. Fortunately, you can still streamline a perfect billing practice and that too, without spending a dime on recruiting and retaining a team of in-house billers. Wondering how? You can simply have your radiology billing solution outsourced by a professional RCM company. Experts in a professional radiology billing company know what it takes to ensure clean claims so that your practice can always get paid on time, while staying compliant with regulations. So, hire a perfect billing company and enjoy excellent cash flow!