ICD-10 Coding for Inconclusive Mammogram(R92.2, R92.30)
Complete ICD-10-CM coding and documentation guide for Inconclusive Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Inconclusive Mammogram
R92.2-R92.3Primary Range
Abnormal and inconclusive findings on diagnostic imaging of breast
This range includes codes for inconclusive mammogram results, with specific codes for dense breast tissue.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R92.2 | Inconclusive mammogram | Use when a mammogram is inconclusive for reasons other than breast density. |
|
| R92.30 | Dense breasts NOS | Use when a mammogram is inconclusive due to dense breast tissue. |
|
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 inconclusive mammogram
Essential facts and insights about Inconclusive Mammogram
Primary ICD-10-CM Codes for inconclusive mammogram
Decision Criteria
clinical Criteria
- Inconclusive due to non-density-related factors
coding Criteria
- Avoid using with Z12.31 due to Excludes1 note
Applicable To
- Inconclusive mammogram not due to dense breast tissue
Clinical Validation Requirements
- Technical limitations such as motion artifact
- Incomplete visualization not due to breast density
Code-Specific Risks
- Incorrectly using R92.2 for dense breasts can lead to claim denials.
Coding Notes
- Ensure documentation specifies the reason for inconclusiveness.
R92.30 - Dense breasts NOS
Use when a mammogram is inconclusive due to dense breast tissue.
Applicable To
- Inconclusive mammogram due to dense breast tissue
Excludes
- Inconclusive mammogram not due to dense breast tissue (R92.2)
Clinical Validation Requirements
- Documentation of breast density affecting imaging results
Coding Notes
Ensure documentation includes ACR density category.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other screening for malignant neoplasm of breast
Z12.39Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Inconclusive Mammogram to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R92.2.
Impact
Clinical: Inadequate follow-up care planning., Regulatory: Non-compliance with MQSA documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Ensure BI-RADS category is included in all reports., Use templates to standardize documentation.
Impact
Reimbursement: Claim denials for incorrect coding., Compliance: Non-compliance with updated coding guidelines., Data Quality: Inaccurate data reporting for breast density issues.
Mitigation Strategy
Use R92.30-R92.34 for dense breasts.
Impact
Using outdated codes for dense breast tissue can trigger audits.
Mitigation Strategy
Regularly update coding practices and educate staff on changes.
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 Inconclusive Mammogram, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Inconclusive Mammogram
Use these documentation templates to ensure complete and accurate documentation for Inconclusive Mammogram. These templates include all required elements for proper coding and billing.
Inconclusive mammogram due to dense breast tissue
Specialty: RadiologyRequired Elements
- BI-RADS category
- ACR density category
- Recommendation for follow-up imaging
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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