ICD-10 Coding for Routine Mammogram(Z12.31, Z85.3)
Complete ICD-10-CM coding and documentation guide for Routine Mammogram. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Routine 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 patients. |
|
| Z85.3 | Personal history of malignant neoplasm of breast | Use as a secondary code when the patient has a history of breast cancer. |
|
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 routine mammogram
Essential facts and insights about Routine Mammogram
Primary ICD-10-CM Codes for routine mammogram
Decision Criteria
clinical Criteria
- Patient is over 40 years old and asymptomatic.
documentation Criteria
- Documentation must state 'routine screening' and 'asymptomatic'.
Applicable To
- Routine screening mammogram
Excludes
- Diagnostic mammogram (R92.8)
Clinical Validation Requirements
- Patient is asymptomatic
- No personal history of breast cancer
Code-Specific Risks
- Incorrectly using with diagnostic codes
Coding Notes
- Ensure documentation clearly states the screening nature of the mammogram.
Z85.3 - Personal history of malignant neoplasm of breast
Use as a secondary code when the patient has a history of breast cancer.
Applicable To
- History of breast cancer
Excludes
- Current breast cancer (C50.-)
Clinical Validation Requirements
- Documented history of breast cancer
Coding Notes
Ensure history of breast cancer is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Screening digital breast tomosynthesis (DBT)
+77063Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Abnormal mammogram
R92.8Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Routine 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: Misclassification of procedure type., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use templates with required phrases, Regular training on documentation standards
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use Z12.31 for screening and R92.8 for diagnostic findings.
Impact
Incorrectly coding a diagnostic mammogram as a screening.
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 Routine Mammogram, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Routine Mammogram
Use these documentation templates to ensure complete and accurate documentation for Routine Mammogram. These templates include all required elements for proper coding and billing.
Routine Screening Mammogram
Specialty: RadiologyRequired Elements
- Patient age
- Screening indication
- Imaging technique
- Findings
- BI-RADS category
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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