Diagnostic Mammogram (one breast)

What it is

A screening mammogram is a fixed set of pictures taken the same way for everybody, looking for something nobody yet suspects. A diagnostic mammogram is the opposite: there is already a question, and the imaging is shaped around it. A radiologist is typically on site while it is happening, looking at the films as they appear and asking for more — a view from a different angle, a magnified view of a cluster of specks, a view with the tissue compressed over a smaller area to spread it out. The study ends when the question is answered rather than after a set number of pictures. This code covers that process done on one breast. That is the usual situation when a woman feels a lump on one side, or when a screening study raised a concern about a single area and she has been called back to look at it properly.

Why it is done

• To work up a lump, a thickened area, or a change in the shape of one breast
• To investigate nipple discharge, skin dimpling, or an inward-turning nipple on one side
• To take a closer look at an area flagged on a screening mammogram, after a call-back
• To re-examine a spot that a previous study asked to see again after an interval
• To follow up an area in a breast that has already been treated for cancer

What to expect

Deodorant, powder and lotion are usually asked to be left off, because particles on the skin can mimic the fine white specks the radiologist is looking for. Old films or a disc from a previous facility are genuinely useful — a great deal of breast imaging rests on comparing today's picture with last year's. The breast is placed on a plate and firmly compressed for a few seconds per image, which is briefly uncomfortable and necessary: the tissue has to be spread thin. Because views are added as the radiologist decides, the appointment is less predictable than a screening one, and an ultrasound of the same area is often done in the same visit. Results are frequently given before you leave.

Questions worth asking

• A diagnostic mammogram is not a screening mammogram for billing purposes. Plans that cover screening with no cost sharing often apply the deductible and coinsurance to this one. Ask your insurer how it will be processed.
• Ask whether tomosynthesis, the three-dimensional version, is being added. It carries its own code and its own charge alongside this one.
• If an ultrasound is done in the same visit, that is a further code again. Ask for an estimate that includes it.
• Ask whether the radiologist's interpretation is billed separately from the facility's technical charge.
• Ask what the charge would be if imaging of the other breast is added on the day. A bilateral study is a different code, not a doubled one.