ICD-10 Coding for Abnormal Mammogram(R92.0, R92.1, R92.2, R92.3, R92.8)
Complete ICD-10-CM coding and documentation guide for Abnormal Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Abnormal Mammogram
R92.0-R92.8Primary Range
Abnormal findings on diagnostic imaging of breast
This range includes codes for various abnormal findings identified during mammographic imaging.
Encounter for screening mammogram for malignant neoplasm of breast
Used when a screening mammogram is performed and abnormal findings are discovered.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R92.0 | Mammographic microcalcification found on diagnostic imaging of breast | Use when microcalcifications are identified on a mammogram. |
|
| R92.1 | Mammographic calcification found on diagnostic imaging of breast | Use when macrocalcifications are identified on a mammogram. |
|
| R92.2 | Inconclusive mammogram | Use when mammogram results are inconclusive. |
|
| R92.3 | Mammographic density | Use when mammographic density is noted. |
|
| R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Use for other abnormal findings not classified under specific codes. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for abnormal mammogram
Essential facts and insights about Abnormal Mammogram
Primary ICD-10-CM Codes for abnormal mammogram
Decision Criteria
clinical Criteria
- Presence of microcalcifications on imaging
Applicable To
- Cluster of microcalcifications
Excludes
- Confirmed malignant neoplasm (C50.-)
Clinical Validation Requirements
- Microcalcifications confirmed on magnification views
Code-Specific Risks
- Ensure laterality is documented.
Coding Notes
- Ensure documentation specifies 'cluster of microcalcifications' and laterality.
R92.1 - Mammographic calcification found on diagnostic imaging of breast
Use when macrocalcifications are identified on a mammogram.
Applicable To
- Coarse calcifications
Excludes
- Confirmed malignant neoplasm (C50.-)
Clinical Validation Requirements
- Calcifications confirmed on imaging
Coding Notes
Ensure documentation specifies 'coarse calcifications' and laterality.
R92.2 - Inconclusive mammogram
Use when mammogram results are inconclusive.
Applicable To
- Inconclusive due to dense breast tissue
Excludes
- Confirmed malignant neoplasm (C50.-)
Clinical Validation Requirements
- BI-RADS 0 or 3 assessment documented
Coding Notes
Ensure documentation specifies the reason for inconclusiveness.
R92.3 - Mammographic density
Use when mammographic density is noted.
Applicable To
- Dense breast tissue
Excludes
- Confirmed malignant neoplasm (C50.-)
Clinical Validation Requirements
- ACR breast density category (A-D) or quantitative percentage
Coding Notes
Ensure documentation specifies the type of density.
R92.8 - Other abnormal and inconclusive findings on diagnostic imaging of breast
Use for other abnormal findings not classified under specific codes.
Applicable To
- Masses
- Architectural distortion
Excludes
- Confirmed malignant neoplasm (C50.-)
Clinical Validation Requirements
- Description of mass size, shape, margins
Coding Notes
Ensure documentation specifies the nature of the abnormal finding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening mammogram for malignant neoplasm of breast
Z12.31Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Abnormal Mammogram to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R92.0.
Impact
Clinical: Leads to unclear follow-up recommendations., Regulatory: Non-compliance with reporting standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Ensure BI-RADS category is included in every mammogram report.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on mammogram purpose.
Mitigation Strategy
Use symptom code like N63.0 first.
Impact
Reimbursement: Claims may be denied for lack of specificity., Compliance: Fails to meet documentation standards., Data Quality: Reduces accuracy of patient records.
Mitigation Strategy
Always document the side of the breast involved.
Impact
Using Z12.31 for diagnostic mammograms can lead to audits.
Mitigation Strategy
Ensure the purpose of the mammogram is clearly documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Abnormal Mammogram, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Abnormal Mammogram
Use these documentation templates to ensure complete and accurate documentation for Abnormal Mammogram. These templates include all required elements for proper coding and billing.
Abnormal mammogram with microcalcifications
Specialty: RadiologyRequired Elements
- Clinical history
- Comparison to prior studies
- Findings
- Impression
- Recommendations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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