What is the ICD‑10‑CM code for a routine screening mammogram?

ICD-10-CM Code for Routine Screening Mammogram

The ICD-10-CM code Z12.31 is the correct and specific code for routine screening mammography in asymptomatic patients. 1, 2

Primary Coding Guideline

• Z12.31 is exclusively designated for screening mammography encounters in asymptomatic women with no breast symptoms, signs, or history of active breast disease 1, 2
• This code signifies that the purpose of the encounter is preventive screening rather than diagnostic evaluation 1
• The code applies to all age groups undergoing routine screening, whether annual or biennial intervals 2

Critical Coding Distinctions

You must NOT use Z12.31 if any of the following are present:

• Any breast symptoms (pain, palpable mass, nipple discharge, skin changes) – these require symptom-specific diagnostic codes 2, 3
• Follow-up of a prior abnormal screening finding – subsequent imaging requires diagnostic coding, not Z12.31 1, 2
• Short-interval follow-up of probably benign findings (BI-RADS 3) – use appropriate diagnostic codes instead 1

The presence of breast symptoms always overrides the use of Z12.31, regardless of whether the patient is due for routine screening 2

Appropriate Secondary Codes

When using Z12.31 as the primary code, consider adding relevant secondary codes for documentation:

• Z85.3 for personal history of breast cancer 1
• Z80.3 for family history of breast malignancy 1
• Z15.01 for known genetic mutations (BRCA1/BRCA2) 1
• Z84.89 for other genetic predisposition 1

Common Coding Pitfalls to Avoid

• Do not use Z12.39 (general screening for malignant neoplasm of other sites) when the more specific Z12.31 is appropriate 1
• Do not use Z01.89 (encounter for other specified special examinations) as it is too general for breast cancer screening 1
• Do not use diagnostic codes N60-N65 (breast disorders) for screening examinations 1
• Do not confuse screening digital breast tomosynthesis with diagnostic DBT – screening DBT uses Z12.31, while diagnostic DBT requires separate diagnostic codes 2

Clinical Context

• Z12.31 applies to screening mammography regardless of breast density, though supplemental screening modalities may be considered separately 2
• The code is appropriate for women aged 40 and older undergoing routine screening, as well as high-risk women under 40 who qualify for screening 1, 2
• Screening continues with Z12.31 for women aged 70-74 if life expectancy exceeds 10 years 2