ICD-10 Coding for Breast Screening(Z12.31, Z80.3, R92.2)
Complete ICD-10-CM coding and documentation guide for Breast Screening. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Screening
Z12.31Primary Range
Encounter for screening mammogram for malignant neoplasm of breast
Primary code for routine breast cancer screening in asymptomatic patients.
Family history of malignant neoplasm of breast
Used as an ancillary code to indicate family history of breast cancer.
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 breast cancer screening in asymptomatic patients. |
|
| Z80.3 | Family history of malignant neoplasm of breast | Use as a secondary code when family history is documented. |
|
| 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 breast screening
Essential facts and insights about Breast Screening
Primary ICD-10-CM Codes for breast screening
Decision Criteria
clinical Criteria
- Patient must be asymptomatic for screening code use.
documentation Criteria
- Order must specify 'screening mammogram'.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram
Clinical Validation Requirements
- Patient is asymptomatic
- Order specifies 'screening mammogram'
Code-Specific Risks
- Using for diagnostic mammograms
Coding Notes
- Ensure documentation specifies 'screening' to avoid denials.
Z80.3 - Family history of malignant neoplasm of breast
Use as a secondary code when family history is documented.
Applicable To
- Family history of breast cancer
Clinical Validation Requirements
- Documented family history of breast cancer
Coding Notes
Ensure family history is clearly documented.
R92.2 - Inconclusive mammogram
Use when mammogram results are inconclusive due to dense breast tissue.
Applicable To
- Dense breast tissue
Clinical Validation Requirements
- Radiologist report indicates dense breast tissue
Coding Notes
Ensure radiologist report supports use of this code.
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.
Mammographic calcifications requiring follow-up
R92.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast 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: Missed risk stratification for breast cancer., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of risk adjustment factor.
Mitigation Strategy
Always document family history during patient intake.
Impact
Reimbursement: Claims may be denied if incorrect code is used., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on screening vs. diagnostic procedures.
Mitigation Strategy
Use appropriate diagnostic codes based on findings.
Impact
Incorrect use of screening codes for diagnostic procedures.
Mitigation Strategy
Ensure orders specify 'screening' and verify patient symptoms.
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 Breast Screening, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Screening
Use these documentation templates to ensure complete and accurate documentation for Breast Screening. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Indication for screening
- Family history
- Radiologist findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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