Table 1.

Codes used to identify breast diagnoses and diagnostic procedures^a,^b

Diagnosis or procedure	Codes/criteria
Breast cancer	ICD-9-CM diagnosis codes 174.xx, 198.81, 233.0, 238.3, or 239.3
Breast-related diagnosis	ICD-9-CM diagnosis codes 174.0x–174.9x; 198.81, 233.0x, 238.3x, 239.3x, 610.0x–612.1x, 675.80, 757.6x, 793.89, 879.0x, 879.1x, V10.3x, V16.3x, V51.0x, V76.10–V76.19, V84.01
Diagnostic mammography	CPT codes 77055 or 77056; or ICD-9-CM procedure code 87.36 or 87.37; or HCPCS code G0204 or G0206
Tomosynthesis	CPT code 77057 or HCPCS code G0202 in combination with CPT code 76499 if prior to January 1, 2015; CPT code 77057 or HCPCS code G0202 in combination with CPT code 77063 if after January 1, 2015; CPT code 77055 or 77056, or HCPCS code G0204 or G0206 in combination with CPT code 76499 if prior to January 1, 2015; HCPCS code G0204 or G0206 in combination with HCPCS code G0279 if after January 1, 2015 (Medicare); CPT code 77055 or 77056, in combination with CPT code 77061 or 77062, or HCPCS code G0204 or G0206 in combination with CPT code 77061 or 77062 if after January 1, 2015 (commercial)
Ultrasound	CPT code 76641, 76642, 76645, or revenue code 3014F
MBI	CPT code 78800 or 78801
MRI	CPT code 77022, 76498, 77058, or 77059; or HCPCS codes C8903–C8908 or CPT code 0159T
Biopsyc,d	ICD-9-CM procedure codes 85.1, 85.11, 85.12; or CPT codes 10021, 10022, 19081, 19083, 19085, 19100, 19101, 19102, 19103, 19120, 19125, 19126, 19281, 19282, 19283, 19286, 19287, 19288, 19290, 19291, 19295, 76098, 76942, 77021, 77031, 77032, 99070; or HCPCS codes A4550, A4649

Notes:

^aNote that screening mammography was not used as a patient selection criterion; however, subsequent analyses identified patients having a screening mammogram during the pre-index period, identified in claims using ICD-9-CM procedure codes V76.11, V76.12, V76.19, HCPCS code G0202, or CPT code 77057.

^bThis table shows the coding used over the time period of this study. Note that numerous CPT codes and code definitions changed during this time.

^cBiopsy coding was for diagnostic breast biopsy only, and did not include axillary biopsies or preoperative needle localization/seed/SAVI^® localization.

^dBiopsy coding was used to identify surgical biopsy procedures as well as ancillary procedures associated with the actual surgical biopsy.

Abbreviations: CPT, Common Procedural Terminology code; HCPCS, Healthcare Common Procedure Coding System code; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code; MBI, molecular breast imaging; MRI, magnetic resonance imaging.