ICD-10 Coding for Diagnostic Mammogram with Ultrasound(R92.0, R92.2)
Complete ICD-10-CM coding and documentation guide for Diagnostic Mammogram with Ultrasound. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diagnostic Mammogram with Ultrasound
R92.0-R92.2Primary Range
Abnormal and inconclusive findings on diagnostic imaging of breast
These codes capture abnormal findings on breast imaging, crucial for diagnostic mammograms.
Unspecified lump in breast
Used when a lump is detected during imaging, requiring further diagnostic evaluation.
Encounter for screening mammogram for malignant neoplasm of breast
Applicable for screening scenarios, often leading to diagnostic follow-up.
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 diagnostic mammogram. |
|
| R92.2 | Inconclusive mammogram | Use when mammogram results are inconclusive due to breast density. |
|
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 diagnostic mammogram with ultrasound
Essential facts and insights about Diagnostic Mammogram with Ultrasound
Primary ICD-10-CM Codes for diagnostic mammogram with ultrasound
Decision Criteria
clinical Criteria
- Microcalcifications noted on imaging
Applicable To
- Microcalcifications detected on mammogram
Excludes
- Benign calcifications (D24.0)
Clinical Validation Requirements
- Presence of microcalcifications on mammogram
Code-Specific Risks
- Misclassification if calcifications are benign
Coding Notes
- Ensure documentation specifies microcalcification presence.
R92.2 - Inconclusive mammogram
Use when mammogram results are inconclusive due to breast density.
Applicable To
- Dense breast tissue
Excludes
- Normal mammogram (Z12.31)
Clinical Validation Requirements
- Dense breast tissue obscuring mammographic findings
Coding Notes
Document breast density and its impact on imaging results.
Differential 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 Diagnostic Mammogram with Ultrasound to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R92.0.
Impact
Clinical: Inadequate risk stratification for follow-up, Regulatory: Non-compliance with reporting standards, Financial: Potential claim denials
Mitigation Strategy
Include BI-RADS category in all mammogram reports, Use templates to ensure completeness
Impact
Reimbursement: Claims may be denied or underpaid., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate procedure data.
Mitigation Strategy
Use -50 modifier for bilateral procedures or specify -RT and -LT for each side.
Impact
Improper use of modifiers for bilateral procedures can trigger audits.
Mitigation Strategy
Ensure correct modifier application for each procedure type.
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 Diagnostic Mammogram with Ultrasound, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diagnostic Mammogram with Ultrasound
Use these documentation templates to ensure complete and accurate documentation for Diagnostic Mammogram with Ultrasound. These templates include all required elements for proper coding and billing.
Diagnostic mammogram with ultrasound for palpable mass
Specialty: RadiologyRequired Elements
- Patient history
- Imaging technique
- Findings
- BI-RADS assessment
- Recommendations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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