What is the ICD-10 (International Classification of Diseases, 10th Revision) code for a screening mammogram order?

ICD-10 Code for Screening Mammogram Order

The appropriate ICD-10 code for a screening mammogram order is Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast). 1

Coding Guidelines for Screening Mammography

• Z12.31 is the specific ICD-10 code designated for screening mammography encounters when there are no symptoms, signs, or history of breast disease 1
• This code should be used when ordering routine screening mammograms for asymptomatic patients 1
• The code indicates that the purpose of the encounter is for preventive screening rather than diagnostic evaluation 1

Screening vs. Diagnostic Mammography Coding

• Screening mammography (Z12.31) is performed on asymptomatic patients with no breast complaints or abnormalities 1
• Diagnostic mammography requires different coding based on the specific indication (symptoms, follow-up of abnormality, etc.) 1
• If the patient has a personal history of breast cancer, use Z85.3 (Personal history of malignant neoplasm of breast) as a secondary code 1

Age-Based Screening Recommendations and Coding

• For women aged 40 and older, annual screening mammography is recommended by many organizations, and Z12.31 would be the appropriate code 1
• For high-risk women under 40 who qualify for screening, Z12.31 would still be the appropriate code, though additional risk factor codes may be beneficial 1
• For transgender patients meeting screening criteria, Z12.31 is still the appropriate code for breast cancer screening 1

Risk-Based Coding Considerations

• For patients with increased risk factors, consider adding appropriate secondary codes:
  • Z80.3 (Family history of malignant neoplasm of breast) for patients with family history 1
  • Z84.89 (Family history of other specified conditions) for genetic predisposition 1
  • Z15.01 (Genetic susceptibility to malignant neoplasm of breast) for patients with known genetic mutations 1

Common Coding Pitfalls to Avoid

• Do not use diagnostic codes (such as N60-N65 breast disorders) for screening examinations 1
• Avoid using general screening code Z12.39 (Encounter for other screening for malignant neoplasm of breast) when the more specific Z12.31 is appropriate 1
• Do not use Z01.89 (Encounter for other specified special examinations) for breast cancer screening as it is too general 1

Follow-Up Coding After Screening

• If a screening mammogram reveals an abnormality requiring additional imaging, the subsequent visit should be coded with the appropriate diagnostic code rather than Z12.31 1
• For short-interval follow-up of probably benign findings (BI-RADS 3), use the appropriate diagnostic code rather than the screening code 1