ICD-10 Code for Routine Mammogram Screening
For routine screening mammography in asymptomatic women aged 40-74 years, use ICD-10 code Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast).
Primary Screening Code
- Z12.31 is the appropriate ICD-10 code for routine screening mammography in asymptomatic average-risk women 1.
- This code specifically designates an encounter for screening purposes, distinguishing it from diagnostic mammography performed for symptomatic patients or follow-up of abnormalities 1.
Age-Specific Screening Recommendations
The screening code Z12.31 applies across the following age groups, though screening frequency varies:
Women Ages 40-44
- Screening mammography is recommended with the code Z12.31, though guidelines vary on whether to begin at age 40 or 45 1, 2.
- The American Cancer Society suggests women have the opportunity to begin annual screening between ages 40-44 1.
Women Ages 45-54
- Annual screening mammography is strongly recommended, coded as Z12.31 1, 2.
- The American Cancer Society recommends annual screening starting at age 45 1.
Women Ages 50-69
- Biennial screening is recommended by most guidelines, though annual screening provides greater mortality reduction (40% vs 23%) 1, 2.
- Use Z12.31 for these screening encounters 1.
Women Ages 70-74
- Screening continues with Z12.31 if life expectancy exceeds 10 years 1, 2.
- European guidelines suggest triennial screening over biennial in this age group 1.
Important Coding Distinctions
Do not confuse screening with diagnostic mammography:
- Z12.31 is exclusively for asymptomatic screening in average-risk women 1.
- Diagnostic mammography (for symptomatic patients or abnormality follow-up) requires different coding based on the specific indication 1.
Additional considerations:
- Women with personal history of breast cancer, genetic mutations (BRCA1/BRCA2), or other high-risk factors may require different coding to reflect their elevated risk status 2.
- The screening code Z12.31 should only be used in the context of organized screening programs with appropriate quality standards 1.
Clinical Context for Proper Code Usage
- Screening mammography reduces breast cancer mortality by 20-40% depending on age and screening frequency 2.
- The code Z12.31 applies regardless of breast density, though supplemental screening may be considered for dense breasts 1.
- Screening should continue as long as life expectancy exceeds 10 years, as mortality benefits require approximately 11 years to fully manifest 2.