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Printer Friendly Version Computer-aided Detection in Conjunction with Digitized Screen-Film Mammography or Full-Field Digital Mammography

Computer-aided Detection in Conjunction with Digitized Screen-Film Mammography or Full-Field Digital Mammography

DESCRIPTION

Computer-aided detection (CAD) has been suggested as an adjunct to screening mammograms to decrease errors in perception (i.e., failure to see an abnormality). The use of CAD systems requires a digital image, either generated by digitization of a prior screen-film mammogram ( digitized mammogram), or generated directly ( direct full-field digital mammogram). Commercially available CAD systems then use computerized algorithms for identifying suspicious regions of interest on the digital image. The locations of the abnormalities are marked such that the reader can then reference the same areas in the original mammogram for further review. The intent of CAD is to aid in detection of potential abnormalities for the radiologist to re-review. The radiologist, not CAD, makes the diagnosis if a clinically significant abnormality exists and whether future diagnostic evaluation is warranted.

The distinction between digitized screen-film mammograms (SFM) and direct full-field digital mammograms (FFDM) is important. Since these two images are generated in different ways, the associated diagnostic performance of adjunctive CAD must be considered separately. Conceptually, the CAD systems used with digital mammography are very similar to those used with film mammography. The computer analyzes the digital images collected directly by the FFDM system, applies a set of algorithms that capture characteristics known to be associated potentially with malignancies, and produces an image with markings that show the site of suspicious findings. Sometimes, different marks are used for suspected masses and suspected microcalcifications. The major difference between CAD for FFDM and CAD for SFM is the extensive data set provided by the former and its interaction with the CAD algorithms.

POLICY

Computer-aided detection devices as an adjunct to single-reader interpretation of digitized screen-film mammograms may be considered medically necessary.

Computer-aided detection devices as an adjunct to single-reader interpretation of direct, full-field digital mammography is considered investigational.

POLICY EXCEPTIONS

Bancorp South (C427, C445, C458, and C550) will provide coverage for computer-aided detection devices as an adjunct to single-reader interpretation of direct, full-field digital mammography.

POLICY GUIDELINES

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

POLICY HISTORY

4/9/2007: Policy added

5/11/2007: Bancorp South (C427, C445, C458, and C550) policy exception added

7/19/2007: Reviewed and approved by the Medical Policy Advisory Committee (MPAC)

5/9/2008: Policy reviewed, no changes

05/08/2013: Policy reviewed; no changes.

SOURCE(S)

Blue Cross Blue Shield Association Policy # 6.01.39

CODE REFERENCE

This is not intended to be a comprehensive list of codes. Some covered procedure codes have multiple descriptions.

The code(s) listed below are ONLY covered if the procedure is performed according to the "Policy" section of this document.

Covered Codes

Code Number	Description
CPT-4
77051	Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography (List separately in addition to code for primary procedure) Note: 77051 must be reported with code 77055 or 77056
77052	Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (List separately in addition to code for primary procedure) Note: 77052 must be reported with code 77057
77055	Mammography; unilateral Note: Use codes 77055 or 77056 with code 77051 for computer-aided detection applied to a diagnostic mammogram
77056	Mammography; bilateral Note: Use codes 77055 or 77056 with code 77051 for computer-aided detection applied to a diagnostic mammogram
77057	Screening mammography, bilateral (2-view film study of each breast) Note: Use code 77052 with code 77057 for computer-aided detection applied to a screening mammogram
ICD-9 Procedure

ICD-9 Diagnosis

HCPCS
G0202	Screening mammography, producing direct digital image, bilateral, all views
G0204	Diagnostic mammography, producing direct digital image, bilateral, all views
G0206	Diagnostic mammography, producing direct digital image, unilateral, all views

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