This Ordering Guide is meant to assist physicians when ordering a medical imaging exam with Quantum Radiology. The guide includes common indications as well as recommendations for the most appropriate examination.
Examinations may be further tailored to a patient’s specific condition. When ordering an exam, please include the clinical question/specific condition in question so that the appropriate imaging can be performed.
Please contact Wellstar Medical Imaging 678.581.5900
Please visit www.wellstar.org
| General | |
| Asymptomatic women age 40 and over, unless pregnant or lactating (wait six months after breastfeeding) | Annual screening mammogram |
| Patient with a New Lump or Focal Pain | |
| Age 30 and over | Bilateral diagnostic mammogram, with targeted ultrasound if needed (provide size, o'clock position, and distance from the nipple) |
| Age 29 and under | Unilateral targeted breast ultrasound (provide size, o'clock position, and distance from the nipple) |
| History of Breast Cancer | |
| Asymptomatic women with a personal history of breast cancer within the past five years | Annual diagnostic mammogram |
| Asymptomatic women with a personal history of breast cancer occuring more than five years ago | Annual diagnostic mammogram |
| Nipple Discharge | |
| Bloody or clear | Consider surgical consult (for possible ductogram) |
| Elderly Patients | |
| Asymptomatic, symptomatic, and/or history of breast cancer | Perform screening or diagnostic mammogram as appropriate if patient is physically able, has an expected life span of: 5-7 years (consider in light of current age/health status), and will follow through on additional testing and suggested treatment plans should breast cancer be diagnosed |
| Male Patients | |
| Male patients with breast mass/symptoms | Bilateral diagnostic mammogram, with targeted ultrasound if needed (provide size and o'clock position) |
| Consider High-Risk Screening Breast MRI if your patient is/has: | |
|
Note:
Screening MRI is in addition to - not as a replacement for- annual screening mammography |
| Breast Ultrasound FOR SCREENING | |
| This is currently being investigated but is not a proven screening modality. Therefore, it is not offered at any WellStar facility. | |
| ICD-9 Codes | Description |
| Screening Mammograms | |
| V76.12 | Screening Mammogram - Asymptomatic |
| V76.11 | Screening Mammogram - High Risk |
| Abnormal Mammograms | |
| 793.8 | Abnormal Mammogram - Unspecified |
| 793.81 | Abnormal Mammogram - Micocalcification |
| 793.82 | Abnormal Finding Inconclusive Mammogram |
| 793.89 | Abnormal Findings - Other |
| Breast Symptoms | |
| 610 | Single Cyst of Breast |
| 610.1 | Fibrocystic Disease of Breast |
| 611.71 | Breast Pain or Tenderness |
| 611.72 | Lump or Mass in Breast |
| 611.79 | Other Signs or Symptoms of the Breast |
| 611.89 | Other Specified Disorders of the Breast |
| History of Breast Cancer | |
| V10.3 | History of Breast Cancer |
| V16.3 | Family History of Breast Cancer |
| ICD-10 Codes | Description |
| Screening Mammograms | |
| Z12.31 | Screening Mammogram - Asymptomatic
Screening Mammogram - High Risk |
| Abnormal Mammograms | |
| R92.0 | Abnormal Mammogram - Microcalcification |
| R92.2 | Abnormal Finding Inconclusive Mammogram |
| R92.1 (Calcification)
R92.8 (Other) |
Abnormal Findings - Other |
| Breast Symptoms | |
| N60.0 | Solitary Cyst of Breast |
| N60.1_* | Diffuse Cystic Mastopathy |
| * specify laterality - 1 = Right 2 = Left 9 = Unspecified | |
| N63 | Unspecified Lump or Mass in Breast |
| N64.4 | Breast Pain or Tenderness |
| N64.5_* | Other Signs or Symptoms of the Breast |
| * 1 = Induration of Breast 2 = Nipple Discharge
3 = Retraction of Nipple 9 = Other Signs/Symptoms in Breast) |
|
| N64.89 | Other Signs or Symptoms of the Breast |
| History of Breast Cancer | |
| Z85.3 | History of Breast Cancer |
| Z80.3 | Family History of Breast Cancer |
Classify
Initial work-up
| Under 30 Years Old | |
| If Ultrasound Shows a Very Suspicious Finding | Mammogram may be requested by the radiologist (extremely rare) Biopsy may be indicated and performed before a mammogram If benign, no mammogram needed |
| If Ultrasound is Negative | Clinical correlation is next step.
If very strong clinical suspicion, mammogram could be obtained as a planning tool prior to biopsy |
| If Ultrasound is Benign (e.g. Cyst) | Clinical follow up |
| If Ultrasound is Probably Benign | Short follow up Ultrasound |
| Over 30 Years Old | |
| Review Order for Documentation | Order to include location by o'clock position and distance from nipple
Address any documented lump or patient detected lump If patient does not feel and no documentation, contact ordering clinician's office and attempt to obtain notes (or review Epic notes). If information is not obtainable, document attempt to obtain information |
| If Baseline | Bilateral Diagnostic Mammogram with lump marked
Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
| If Patient Has Had a Prior Baseline and Under 40 Years Old | Unilateral Diagnosistic / Bilateral Diagnostic (bilateral if prior not in system)
Targeted Ultrasound |
| If Last Mammogram Was Less than 6 Months Ago | Targeted Ultrasound
Mammogram if needed |
| Over 40 Years Old | |
| If Close to One Year or More Since Prior | Bilateral Diagnostic Mammogram with lump marked
Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
| If Last Mammogram was Less than 6 Months Ago | Targeted Ultrasound
Mammogram if needed |
| If Last Mammogram was Greater than 6 Months but Less than 12 Months | Unilateral Diagnostic Mammogram with lump marked
Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
Who:
Intermediate Risk Women – Still Controversial:
Tomosynthesis is now available at WellStar:
Notes:
790 Church Street, Suite 400, Marietta, GA 30060
(678) 239-0420
For Billing Questions, please call 1 (855) 871-1526
