What are the appropriate ICD-10-CM codes for ordering a bone density scan (DXA) as a screening test and a mammogram as a screening exam?

ICD-10 Codes for Ordering Bone Density Scan and Mammogram

For screening bone density scans (DXA), use Z13.820 (Encounter for screening for osteoporosis), and for screening mammograms, use Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast).

Bone Density Scan (DXA) Coding

The appropriate ICD-10-CM code for ordering a screening bone density scan is Z13.820 (Encounter for screening for osteoporosis). This code applies when ordering DXA as a preventive screening test in asymptomatic patients who meet screening criteria.

When to Use Screening vs. Diagnostic Codes

• Use Z13.820 when ordering DXA for screening purposes in patients without symptoms or known osteoporosis
• Use diagnostic codes (M80.x-M81.x series) if the patient has:
  • Known osteoporosis
  • History of fragility fractures
  • Symptoms suggesting bone disease
  • Medical conditions or medications associated with bone loss

Key Screening Populations

Based on the 2025 USPSTF guidelines 1, screening DXA is recommended for:

• All women age 65 years and older
• Postmenopausal women younger than 65 years with elevated fracture risk (use 2-step approach with fracture risk assessment tool followed by DXA if indicated)

Common Pitfall: Do not use Z13.820 for men or patients with known bone disease—these require diagnostic codes. The USPSTF explicitly states their screening recommendation does not apply to individuals with medical conditions or medications associated with bone loss 1.

Mammogram Coding

The appropriate ICD-10-CM code for ordering a screening mammogram is Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast). This applies to asymptomatic patients undergoing routine breast cancer screening.

When to Use Screening vs. Diagnostic Codes

• Use Z12.31 for routine screening mammography in asymptomatic patients
• Use diagnostic codes (N63.x for breast lump, R92.x for abnormal mammogram findings, Z85.3 for personal history of breast cancer, etc.) when ordering mammography for:
  • Evaluation of breast symptoms (lump, pain, discharge)
  • Follow-up of abnormal findings
  • Diagnostic workup

Screening Recommendations by Risk Category

According to the 2025 ACR Appropriateness Criteria 222:

• Average risk females: DBT screening or standard mammography screening
• Intermediate risk females: DBT screening or standard mammography screening
• High risk females ≥30 years: Mammography/DBT PLUS MRI (complementary, not alternatives)
• High risk females <30 years: MRI screening (with or without mammography)

Common Pitfall: For high-risk patients, mammography and MRI are complementary examinations that maximize cancer detection when used together, not alternatives 222. Using only Z12.31 may be insufficient documentation for high-risk patients requiring both modalities—consider adding Z15.01 (genetic susceptibility to breast cancer) or Z80.3 (family history of breast cancer) as secondary codes to justify the medical necessity of supplemental screening.

Documentation Considerations

When ordering these screening tests, ensure documentation supports the screening indication. If a patient does not meet standard screening criteria but you believe the test is medically necessary, document the specific clinical rationale and consider obtaining an advance beneficiary notice (ABN) to inform the patient of potential payment responsibility 3.