ICD-10 Coding for Diagnostic Mammogram(C50.911, R92.2)
Complete ICD-10-CM coding and documentation guide for Diagnostic Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diagnostic Mammogram
C50-C50.929Primary Range
Malignant neoplasm of breast
Used for confirmed cases of breast cancer identified through diagnostic mammography.
Abnormal and inconclusive findings on diagnostic imaging of breast
Used for abnormal findings on diagnostic mammograms that require further investigation.
Personal history of malignant neoplasm of breast
Used for patients with a history of breast cancer undergoing diagnostic mammography.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C50.911 | Malignant neoplasm of unspecified site of right female breast | Use when a biopsy confirms breast cancer in the right breast. |
|
| R92.2 | Inconclusive mammogram | Use when mammogram results are inconclusive and further testing is needed. |
|
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
Essential facts and insights about Diagnostic Mammogram
Primary ICD-10-CM Codes for mammogram diagnostic
Decision Criteria
clinical Criteria
- Biopsy confirms invasive ductal carcinoma
Applicable To
- Breast cancer confirmed by biopsy
Excludes
- Benign neoplasm of breast (D24.-)
Clinical Validation Requirements
- Pathology report confirming malignancy
- Imaging findings consistent with cancer
Code-Specific Risks
- Misclassification if malignancy is not confirmed
Coding Notes
- Ensure biopsy confirmation before using this code.
R92.2 - Inconclusive mammogram
Use when mammogram results are inconclusive and further testing is needed.
Applicable To
- Inconclusive findings on mammogram
Excludes
- Definitive diagnosis of breast cancer (C50.-)
Clinical Validation Requirements
- Radiology report indicating inconclusive results
- Recommendation for additional imaging or biopsy
Coding Notes
Document the need for additional imaging or biopsy clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
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 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C50.911.
Impact
Clinical: Ambiguity in patient care, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify left or right breast in documentation, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect reimbursement rates, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data
Mitigation Strategy
Ensure diagnostic codes are used when symptoms or findings warrant further investigation.
Impact
Missing key elements such as laterality or BI-RADS category can trigger audits.
Mitigation Strategy
Use comprehensive templates and checklists.
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 expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diagnostic Mammogram
Use these documentation templates to ensure complete and accurate documentation for Diagnostic Mammogram. These templates include all required elements for proper coding and billing.
Diagnostic Mammogram for Abnormal Findings
Specialty: RadiologyRequired Elements
- Patient history
- Clinical findings
- Imaging technique
- Results
- BI-RADS category
- Recommendations
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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