Frequently Asked Questions

Why is CAD important in the detection of breast cancer?

The widespread use of regular mammography screening has been a major contributor to improvements in breast cancer survival rates. While mammography has been proven to be a powerful tool in the fight against breast cancer, the accurate reading of mammograms can sometimes be difficult. Even the most trained eye can miss subtle variations in tissue that may be of concern. The result is that approximately 15 percent of cancers go undetected by screening mammography.

Why is this technology necessary?

According to the American Cancer Society (ASC), breast cancer is the leading cause of cancer death among women ages 35-54 in the United States. In 2003 alone, 211,300 new cases of invasive breast cancer occurred among women in the United States. There were 39,800 who died from breast cancer that year.

What are the benefits of early detection in breast cancer?

According to American Cancer Society (ACS) research, the five-year survival rate for breast cancer patients decreases from 96 percent for early stage cancers to 20 percent for late stage cancers that have spread to other organs. By diagnosing breast cancer as early as possible, survival rates will be higher, and the cost to treat the disease will be lower. Cancer patient survival and quality of life are dramatically improved when the cancer is identified at an early treatable stage. Clinical trials demonstrated that the use of the ImageChecker system can result in earlier detection of up to 23.4% of cancers currently detected with screening mammography in those women who had a prior screening mammogram 9 to 24 months earlier.

What percent of cancers are missed when reading mammograms?

U.S. clinical trials of approximately 9,000 patients performed at 18 leading medical institutions across the United States have shown that 26.2 percent of cancers missed by a radiologist would be detected with the use of CAD.

What are some of the challenges in reading mammograms and why are cancers sometimes missed during mammography screening?

The breast is not just a mound of fat. It is a "gland" that has a job to do - to make milk. The glandular tissue is made up of lobules that make milk and pipes called ducts that drain milk out through the nipple.

On a mammogram, the glandular tissue in the breast looks "dense." This means that it is hard to see through, making a cancer more difficult to detect. Some women have denser breasts than others. Dense breasts have more glandular and connective tissue and less fat tissue. Younger women tend to have denser breasts older women. Thinner women tend to have denser breasts than heavier women.

How can CAD technology assists radiologists in reading mammograms?

It acts as a "spell check" or an extra pair of eyes for radiologists by reading and recognizing characteristics often associated with cancer. It also marks suspicious spot for a radiologist's further analysis.

The CAD technology basically works like a second pair of eyes, reviewing a patient's mammogram after the radiologist has already made an initial interpretation. If the computer software detects any breast abnormalities or "regions of interest" on the mammogram, it marks them. The radiologist can then go back and review the mammogram again to determine whether the marked areas are suspicious and require further examination (with additional imaging tests or biopsy). With the CAD technology, the radiologist still makes final interpretation of the mammogram.

Does the use of CAD require any additional procedures for patients?

NO. One of the true benefits of CAD is that it does not require additional procedures for patients. A standard mammogram is all that is needed. In addition, the system adds only minimal time for radiologists. It was designed to easily fit into today's busy centers.

How much does it cost to contract with ICA?

There is not cost to the hospital/ facility or radiologist to contract with ICA. The hospital/ facility or radiologist bills third party payors for CAD as an add-on to the mammogram. ICA’s charges to the hospital/facility or radiologist are less than the Medicare’s technical reimbursement.

Do all Payors reimburse for CAD?

Currently over 400 payers nationwide are reimbursing for the CAD procedure. Unfortunately, some insurance payers are not reimbursing at this time. For those patients whose insurances are not reimbursing or those without insurance, a voluntary co-pay charge of $25.00-$45.00 is recommended. Blue Cross and Blue Shield Technology Assessment concluded “…the available evidence suggests that the use of CAD after initial radiographic interpretation as a quality adjunct to single reader mammography improves net health outcomes compared with single-reader radiologist interpretation by increasing true-positive rate without a disproportionate increase in the false positive rate.” Aetna “considered computer-aided detection (CAD) a medically necessary adjunct to mammography.”

What CPT Codes are used to bill for CAD?

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).

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).

When should we bill for CAD?

CAD is an add-on to the primary mammogram, therefore, the CAD CPT code must be billed with the primary mammogram code (at the same time of the screening mammogram).

How much additional time does it take to interpret the CAD Analysis?

The CAD report is viewed at the same time the mammogram is interpreted; therefore, the additional time required is minimal. Studies show that the impact of CAD on a radiologists work flow is minimal. On average, the CAD technology requires an additional 17 seconds to the read.

Is a referral required by a physician?

Diagnostic Tests Rule (42 CFR 410.32) allows for performance of computer-aided detection (CAD) in conjunction with mammography without a written physician order. The radiologist will determine whether or not CAD should be performed. Refer to your Medicare Carriers Manual Transmittal #1725: 15021 (E) (1) Test Design.

Does Imaging Centers of America provide CAD for both Screening and Diagnostic Mammograms?

Most hospital/facilities choose to utilize our services for their screening mammograms to ensure continued prompt results reporting for their patients; however, Imaging Centers of America offers CAD services for either screening or diagnostic mammograms. By utilizing CAD for diagnostic mammograms, most clients will separate their patients into symptomatic and asymptomatic and perform CAD on mammograms rendered to asymptomatic patients for which there is minimal impact associated with a slight delay in results reporting.

What is the impact on workflow?

Once it is determined what mammograms will be sent for CAD, you should identify someone that can segregate the cases. It is usually the role of the technologist. ICA will provide our signature pink courier bags to transport the mammograms. The technologist will place the mammograms in the pink courier bags, and place the bags in a designated area for pick-up (we recommend the technologist work area). ICA will make sure the courier is aware of the designated pick-up and drop-off area. It is advisable to designate an area to hold the master jackets of patient studies that have been sent for CAD analysis. This will simplify the process once the mammograms are returned for interpretation.

What requirements are there to process the films?

The hospital/facility must provide the current screening (film-screen) mammograms. The films must be free of tape, stickers, artifacts, and must be labeled with radiopaque film markers to indicate laterality and mammographic view in accordance with requirements of the MQSA.

How are the films transported?

ICA utilizes courier services, FedEx and DHL for film delivery services based on location.

What if the mammograms are lost during shipment?

ICA acknowledges the very remote possibility that a package may be delayed or lost. If lost, it would be necessary to repeat the mammogram. In this situation, ICA will reimburse the hospital/facility for each mammogram at the current CMS screening mammography reimbursement rate, and the CAD analysis would be performed at no charge. We understand that this happening would present a tremendous inconvenience; however, the improbability of this occurring should provide reassurance to mammography providers and the women they serve.

How long does it take to return the films?

The mammogram films and the CAD printout are typically returned to the hospital/facility within 48 hours.

Will this process delay results reporting?

Although this may delay results reporting, the women and their doctors are generally receptive to a minimal delay for CAD. MQSA requires hospital/facilities to communicate mammography results within 30 days of the examination. By utilizing ICA’s CAD services will not impact the hospital/facility’s ability to comply with federal regulations.

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