ICD-10 Coding for Mammogram Screening(Z12.31, Z80.3, R92.2)
Complete ICD-10-CM coding and documentation guide for Mammogram Screening. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mammogram Screening
Z12.31-Z12.39Primary Range
Encounter for screening for malignant neoplasms
This range includes codes for screening mammograms, which are used to detect breast cancer in asymptomatic patients.
Family and personal history of malignant neoplasms
These codes are used to indicate a family or personal history of cancer, which may justify more frequent screenings.
Abnormal and inconclusive findings on diagnostic imaging of breast
This range includes codes for abnormal findings that may be discovered during a screening mammogram.
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 women aged 40 and older. |
|
| Z80.3 | Family history of malignant neoplasm of breast | Use to indicate a family history of breast cancer, which may justify screening. |
|
| R92.2 | Inconclusive mammogram | Use when mammogram results are 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 screening mammogram
Essential facts and insights about Mammogram Screening
Primary ICD-10-CM Codes for mammogram screening
Decision Criteria
clinical Criteria
- Patient is asymptomatic and aged 40 or older.
coding Criteria
- Use Z12.31 only for screening, not diagnostic purposes.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram (use appropriate diagnostic code)
Clinical Validation Requirements
- Patient is asymptomatic
- Patient is aged 40 or older
- No prior history of breast cancer
Code-Specific Risks
- Incorrectly using for diagnostic mammograms
Coding Notes
- Ensure documentation specifies the screening nature of the mammogram.
Z80.3 - Family history of malignant neoplasm of breast
Use to indicate a family history of breast cancer, which may justify screening.
Applicable To
- Family history of breast cancer
Clinical Validation Requirements
- Documented family history of breast cancer
Coding Notes
Ensure family history is documented in the patient's medical record.
R92.2 - Inconclusive mammogram
Use when mammogram results are inconclusive due to dense breast tissue.
Applicable To
- Dense breast tissue
Clinical Validation Requirements
- Mammogram results indicate dense breast tissue
Coding Notes
Ensure breast density is documented in the radiology report.
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 Mammogram Screening to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z12.31.
Impact
Clinical: Inadequate assessment of breast cancer risk., Regulatory: Non-compliance with MQSA requirements., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Educate radiologists on documentation requirements, Implement checklist for mammogram reports
Impact
Reimbursement: Claims may be denied if Z12.31 is used incorrectly., Compliance: Incorrect coding can lead to non-compliance with coding guidelines., Data Quality: Misclassification of diagnostic procedures as screenings.
Mitigation Strategy
Use Z12.31 only for screening mammograms in asymptomatic patients.
Impact
Missing BI-RADS or breast density in mammogram reports.
Mitigation Strategy
Implement mandatory fields in EHR for BI-RADS and breast density.
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 Mammogram Screening, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mammogram Screening
Use these documentation templates to ensure complete and accurate documentation for Mammogram Screening. These templates include all required elements for proper coding and billing.
Routine screening mammogram
Specialty: RadiologyRequired Elements
- Indication for screening
- BI-RADS category
- Breast density
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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