ICD-10 Coding for Screening Mammography(Z12.31, 77065)
Complete ICD-10-CM coding and documentation guide for Screening Mammography. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Screening Mammography
Z12-Z13Primary Range
Encounter for screening for other diseases and disorders
This range includes codes for screening encounters, with Z12.31 specifically for breast cancer screening.
Family history of primary malignant neoplasm
These codes are used as secondary diagnoses to indicate family history of cancer, which may justify high-risk screening.
Personal history of malignant neoplasm
These codes are used to indicate a personal history of cancer, relevant for high-risk screening.
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 asymptomatic patients undergoing routine breast cancer screening. |
|
| 77065 | Diagnostic mammography, unilateral | Use when diagnostic imaging is required due to symptoms or findings. |
|
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 mammography
Essential facts and insights about Screening Mammography
Primary ICD-10-CM Codes for screening mammography
Decision Criteria
clinical Criteria
- Patient must be asymptomatic for screening code use.
documentation Criteria
- Documentation must specify 'routine screening'.
Applicable To
- Routine breast cancer screening
Excludes
- Diagnostic mammogram (77065/77066)
Clinical Validation Requirements
- Patient is asymptomatic
- Routine screening per guidelines
Code-Specific Risks
- Incorrectly using for diagnostic mammograms
Coding Notes
- Ensure documentation states 'asymptomatic' and 'routine screening'.
77065 - Diagnostic mammography, unilateral
Use when diagnostic imaging is required due to symptoms or findings.
Applicable To
- Diagnostic imaging for breast abnormalities
Excludes
- Screening mammogram (Z12.31)
Clinical Validation Requirements
- Presence of breast symptoms or findings
Coding Notes
Ensure symptoms or findings are documented.
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 Screening 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: May lead to inappropriate screening intervals., Regulatory: Non-compliance with screening guidelines., Financial: Potential claim denials for lack of medical necessity.
Mitigation Strategy
Include family and personal history in notes.
Impact
Reimbursement: Claims may be denied for lack of medical necessity., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on screening vs. diagnostic procedures.
Mitigation Strategy
Use appropriate diagnostic codes like 77065 with symptom codes.
Impact
Risk of using screening codes for diagnostic procedures.
Mitigation Strategy
Ensure documentation clearly differentiates between screening and diagnostic purposes.
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 Mammography, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Screening Mammography
Use these documentation templates to ensure complete and accurate documentation for Screening Mammography. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Patient age and risk factors
- Indication for screening
- Clinical findings
- Imaging details
- Results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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