ICD-10 Coding for Mammography(Z12.31, R92.2, C50.911)
Complete ICD-10-CM coding and documentation guide for Mammography. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mammography
Z12.31Primary Range
Encounter for screening mammogram for malignant neoplasm of breast
Primary code for routine screening mammograms in asymptomatic patients.
Abnormal and inconclusive findings on diagnostic imaging of breast
Used for follow-up imaging when initial screening results are inconclusive.
Malignant neoplasm of breast
Used when a diagnostic mammogram identifies a malignant breast tumor.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z12.31 | Encounter for screening mammogram for malignant neoplasm of breast | Use for routine screening mammograms in asymptomatic patients. |
|
| R92.2 | Inconclusive mammogram | Use when initial mammogram results are inconclusive and require follow-up. |
|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when a diagnostic mammogram identifies a malignant tumor in the right breast. |
|
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 screening mammogram
Essential facts and insights about Mammography
Primary ICD-10-CM Codes for mammo
Decision Criteria
clinical Criteria
- Patient is asymptomatic and due for routine screening.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram
Clinical Validation Requirements
- Patient is asymptomatic
- No personal history of breast cancer
Code-Specific Risks
- Incorrectly used for diagnostic mammograms
Coding Notes
- Ensure patient is asymptomatic and has no personal history of breast cancer.
R92.2 - Inconclusive mammogram
Use when initial mammogram results are inconclusive and require follow-up.
Applicable To
- BI-RADS 0 result
Excludes
- Definitive findings of malignancy
Clinical Validation Requirements
- BI-RADS 0 result documented
- Need for additional imaging
Coding Notes
Document the need for additional imaging due to inconclusive results.
C50.911 - Malignant neoplasm of unspecified site of right female breast
Use when a diagnostic mammogram identifies a malignant tumor in the right breast.
Applicable To
- Breast cancer, right side
Excludes
- Benign breast conditions
Clinical Validation Requirements
- Biopsy-confirmed malignancy
- Tumor size and location documented
Coding Notes
Ensure biopsy confirmation and document tumor specifics.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Mammography to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z12.31.
Impact
Clinical: Incomplete assessment of breast cancer risk, Regulatory: Non-compliance with FDA requirements, Financial: Potential claim denials
Mitigation Strategy
Use templates with required fields, Regular training on documentation standards
Impact
Reimbursement: Incorrect reimbursement due to misclassification, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate health data reporting
Mitigation Strategy
Use appropriate diagnostic codes such as R92.2 for inconclusive results.
Impact
Using screening codes for diagnostic purposes can trigger audits.
Mitigation Strategy
Ensure accurate documentation of patient symptoms and history.
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 Mammography, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mammography
Use these documentation templates to ensure complete and accurate documentation for Mammography. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Indication for screening
- Breast density category
- BI-RADS assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Mammography? Ask your questions below.