ICD-10 Coding for Screening Mammogram(Z12.31, R92.2)
Complete ICD-10-CM coding and documentation guide for Screening Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Screening Mammogram
Z12-Z13Primary Range
Encounter for screening for other diseases and disorders
This range includes codes for encounters for screening for various conditions, including breast cancer.
Family and personal history of certain conditions
This range is relevant for documenting family and personal history of breast cancer, which may influence screening decisions.
Abnormal findings on diagnostic imaging and in function studies, without diagnosis
This range includes codes for abnormal findings on imaging studies, such as inconclusive mammograms.
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 a mammogram result is inconclusive and requires further imaging. |
|
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 Screening Mammogram
Primary ICD-10-CM Codes for screening mammogram
Decision Criteria
clinical Criteria
- Patient is asymptomatic and presents for routine screening.
documentation Criteria
- Documentation must state 'screening mammogram'.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram
Clinical Validation Requirements
- Patient is asymptomatic
- No prior abnormal findings
Code-Specific Risks
- Incorrectly using for diagnostic purposes
Coding Notes
- Ensure documentation specifies 'screening' to avoid confusion with diagnostic procedures.
R92.2 - Inconclusive mammogram
Use when a mammogram result is inconclusive and requires further imaging.
Applicable To
- BI-RADS 0
Excludes
- Confirmed malignancy
Clinical Validation Requirements
- BI-RADS 0 result
- Need for additional imaging
Coding Notes
Ensure follow-up imaging is documented.
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 Screening Mammogram to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z12.31.
Impact
Clinical: May miss risk factors influencing screening frequency., Regulatory: Non-compliance with documentation standards., Financial: Potential for incorrect coding and reimbursement issues.
Mitigation Strategy
Always document family history if relevant.
Impact
Reimbursement: May lead to denied claims if incorrectly coded as screening., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on screening vs. diagnostic procedures.
Mitigation Strategy
Use R92.2 or other diagnostic codes when symptoms or abnormal findings are present.
Impact
Using Z12.31 for diagnostic purposes can trigger audits.
Mitigation Strategy
Ensure documentation clearly states the purpose of the mammogram.
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 Screening Mammogram, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Screening Mammogram
Use these documentation templates to ensure complete and accurate documentation for Screening Mammogram. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Patient demographics
- Indication for screening
- Family/personal history
- BI-RADS score
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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