Belgian Society of Radiology News
New Mammography Nomenclature Codes - February 1, 2016
On February 1st, 2016, three new nomenclature codes for screening of women at very high risk (>30% lifetime risk) will be implemented, according to the Royal Decree of November 25th, 2015 (see attachment, pages 1-3):
- 450354-450365 N120 : screening mammography of both breasts in asymptomatic women at very high risk of breast cancer;
- 461134-461145 N70 : screening sonography of both breasts in asymptomatic women at very high risk of breast cancer;
- 459830-459841 N350 : screening MRI of both breasts in asymptomatic women at very high risk of breast cancer.
Very high risk is defined as a life-time risk of ≥ 30% (based on to the criteria of KCE-report 172). It is assessed by the referring physician (using a standardized notification form provided by the RIZIV-INAMI - see attachment, pages 4-5), who submits the notification form to a medical advisor.
Some particularities about the three new nomenclature codes:
- they can only be charged if the referral clearly mentions very high risk (the abovementioned notification form as such is not required);
- they cannot be combined with a consultancy (460670), because the consultancy is incorporated in the honorarium, so the patient gets the examination for free (no co-payment);
- the mammography code (450354-450365) cannot be combined with a forfeit (460972), but this restriction may not apply to MRI (459830-459841) – to be confirmed by RIZIV/INAMI;
- they can be used only once a year; if mammography (450354-450365) or sonography (461134-461145) is used more frequently, this should be motivated in the patient’s medical record;
- they cannot be combined with any of the “regular” mammography nomenclature codes.
In summary, the screening practice for women at very high risk for breast cancer does actually not change, but the tarification converses from a co-payment system to a non-co-payment system for the patient, provided that she has a notification of strongly increased risk by a medical advisor.