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

Medical Policy: 06.01.25 
Original Effective Date: March 2007 
Reviewed: June 2008 
Revised:  

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.

Description: 

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

The distinction between digitized screen-film mammograms and direct full-field mammograms is important. Conceptually, the CAD systems used with digital mammography are very similar to those used with film mammography. The computer analyzes the images collected directly by the FFDM system, applies a set of algorithms that capture the characteristics known to be associated with malignancies, and produces an image with markings that show the site of suspicious findings. The major difference between CAD for full-field digital mammography and CAD for screen-film mammography 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 may be considered medically necessary.

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Procedure Codes and Billing Guidelines: 

• To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.
• CPT code 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)
• CPT code 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)
• HCPCS code G0202 Screening mammography, producing direct digital image, bilateral, all views
• HCPCS code G0204 Diagnostic mammography, producing direct digital image, bilateral, all views
• HCPCS code G0206 Diagnostic mammography, producing direct digital image, unilateral, all views        

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Selected References: 

• Gur D, Sumkin JH, Rockette HE et al. Changes in breast cancer detection and mammography recall rates after the introduction of a computer-aided detection system. J Natl Cancer Inst. 2004 Feb 4; 96(3):185-90.
• Baum F, Fischer U, Obenauer S et al. Computer-aided detection in direct digital full-field mammography: initial results. Eur Radiol 2002; 12:3015-17.
• Taplin SH, Rutter CM, Lehman CD. Testing the effect of computer-assisted detection on interpretive performance in screening mammography. AJR 2006; 187: 1475-82.
• Ko JM, Nicholas MJ, Mendel JB et al. Prospective assessment of computer-aided detection in interpretation of screening mammography. AJR 2006; 187: 1483-91.
• Birdwell RL, Bandodkar P, Ikeda DM. Computer-aided detection with screening mammography in a university hospital setting. Radiology. 2005; 236(2):451-7.
• Pisano ED, Yaffe MJ. Digital Mammography. Radiology 2005; 234: 353-62.
• 2002 Technology Evaluation Center Assessment: Computer-aided Detection in Mammography. Blue Cross Blue Shield Association.
• 2006 Technology Evaluation Center Assessment: Computer-aided Detection with Full-Field Digital Mammography. Blue Cross Blue Shield Association.
• Obenauer S, Sohns C, Werner C et al. Computer-aided detection in full-field digital mammography. Breast J 2006 Jan-Feb; 12(1):16-9.
• Fenton JJ, Taplin SH, Carney PA et al. Influence of computer-aided detection on performance of screening mammography. N Engl J Med. 2007 Apr 5;356(14):1399-409.
• Taylor P, Potts HW. Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer. 2008 Apr;44(6):798-807. Epub 2008 Mar 18.
• Skaane P, Kshirsagar A, Stapleton S et al. Effect of computer-aided detection on independent double reading of paired screen-film and full-field digital screening mammograms. AJR Am J Roentgenol. 2007 Feb; 188(2):377-84.
• Georgian-Smith D, Moore RH, Halpern E et al. Blinded comparison of computer-aided detection with human second reading in screening mammography. AJR Am J Roentgenol. 2007 Nov;189(5):1135-41.
• Gromet M. Comparison of computer-aided detection to double reading of screening mammograms: review of 231,221 mammograms. AJR Am J Roentgenol. 2008 Apr;190(4):854-9.

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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:

Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309

*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.

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