Abnormal screening mammogram- now what?

 First, I order a screening mammogram with the diagnosis code Z12.31 Screening Mammogram for breast cancer. All women annually starting at age 40 unless high risk (disclaimer-look up the guidelines). 

So you ordered a screening mammogram, the patient actually completed it but it comes back abnormal- so what now? I typically order a breast ultrasound and diagnostic mammogram using the diagnosis code R92.8 abnormal screening mammogram. You can specify bilateral, right or left depending on what you want to do. When I first started, I cannot tell you how many times I would get a call back saying something along the lines of “pick another diagnosis code so the prior authorization can be approved.” Thus, creating more busy work that we don’t have time for. So I saved the code above in my EMR and it’s a huge time saver. There are other codes that will work but this is just my go to that is more universal. 

Now to interpret the results of the diagnostic mammogram and US. The report will guide you on what to do next. If it’s normal, then tell the patient we will repeat (insert time frame recommended on report like a year or 6 month) but closely monitor with self breast exams and report any changes or concerns. Sometimes it will recommend breast biopsy. I personally do not order that- when you order in your name, you own it and have to interpret it. My process is to refer to a breast surgeon. Find a go-to surgeon in your area, write it down and keep it for next time. 

NOTE

If the patient has breast pain, lumps, bumps, or other symptoms- bypass the screening mammogram and go straight to the diagnostic mammogram and ultrasound.