ICD-10 Coding for Annual Mammogram(Z12.31)
Complete ICD-10-CM coding and documentation guide for Annual Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Annual Mammogram
Z12-Z13Primary Range
Encounter for screening for malignant neoplasms
This range includes codes for routine screening for breast cancer, which is the primary purpose of an annual mammogram.
Family and personal history of malignant neoplasm
These codes are used to indicate a family or personal history of breast cancer, which can influence screening protocols.
Key Information: ICD-10 code for annual mammogram
Essential facts and insights about Annual Mammogram
Primary ICD-10-CM Code for annual mammogram
Decision Criteria
clinical Criteria
- Patient is asymptomatic and presents for routine screening.
coding Criteria
- Ensure no diagnostic intent is documented.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram (R92.8)
Clinical Validation Requirements
- Patient is asymptomatic
- No current breast symptoms
- Routine screening intent
Code-Specific Risks
- Misuse for diagnostic purposes
- Incorrect sequencing with history codes
Coding Notes
- Always sequence Z12.31 first for screening mammograms.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Annual Mammogram to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z12.31.
Impact
Clinical: Leads to incorrect coding and potential misinterpretation of the patient's care plan., Regulatory: Increases risk of audit due to unclear documentation., Financial: May result in denied claims or reduced reimbursement.
Mitigation Strategy
Ensure clear documentation of screening intent., Use templates to standardize documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misuse can trigger audits., Data Quality: Affects accuracy of health records.
Mitigation Strategy
Ensure documentation specifies 'screening' and not 'diagnostic'.
Impact
Using Z12.31 for diagnostic purposes can trigger audits.
Mitigation Strategy
Ensure documentation clearly states the screening intent.
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 Annual Mammogram, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Annual Mammogram
Use these documentation templates to ensure complete and accurate documentation for Annual Mammogram. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Indication for screening
- Technique used
- Comparison with prior studies
- Breast composition
- Findings and recommendations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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