What Is the ICD 10 Code for Screening Mammogram?
The most widely used ICD 10 code for screening mammogram is Z12.31, which indicates an encounter for screening mammography for malignant neoplasm of the breast. This code is applied during routine mammography exams when the patient shows no symptoms or previous breast cancer history.
When asked, “What ICD-10-CM code is reported for a routine screening mammogram?”, Z12.31 is the correct and standard answer. This code is essential for preventive care documentation, insurance reimbursement, and tracking screening frequency in patient records. It’s also used globally for consistency in research and public health reporting.
ICD 10 Code for Annual Mammogram Screening
An annual mammogram screening for breast cancer is a critical preventive measure, especially for women over 40 or those at high risk. The ICD 10 code for annual mammogram screening is also Z12.31 when the purpose is general screening without current symptoms.
It’s important to note that Z12.31 can be used once every 12 months for patients undergoing routine annual exams. Healthcare providers should ensure accurate coding to align with insurance policies and compliance guidelines, which often limit how frequently this service is covered without additional clinical justification.
ICD 10 Code for Bilateral Mammogram Screening
When a bilateral mammogram screening is performed—meaning both breasts are imaged—the ICD 10 code remains Z12.31. However, additional procedural or CPT codes are typically used alongside it to indicate that the mammogram was bilateral.
In ICD-10-CM, diagnosis codes describe the reason for the visit (screening), not the method or extent of imaging. Therefore, for diagnostic clarity and billing efficiency, Z12.31 is paired with relevant CPT codes. Consistent documentation helps distinguish between routine and follow-up screenings, especially in high-risk populations.
ICD 10 Code for Screening Mammogram with Implants
For women with breast implants, screening mammography may require specialized imaging. The ICD 10 code for screening mammogram with implants is still Z12.31, but radiology teams often use modifiers or CPT-level codes to indicate implant-specific techniques.
Although the diagnostic code remains unchanged, mentioning the presence of implants in clinical notes is essential for accurate billing and image interpretation. Implants can obscure breast tissue, making additional views necessary. As such, Z12.31 ensures the exam is logged as a preventive screening while supplemental codes complete the documentation.
ICD 10 Code for Abnormal Screening Mammogram
If a mammogram reveals suspicious findings, the ICD 10 code for abnormal screening mammogram is R92.8 – “Other abnormal and inconclusive findings on diagnostic imaging of breast.” This code is used after a routine screening (Z12.31) leads to a result that requires additional evaluation.
Z12.31 should be used for the original screening encounter, while R92.8 applies to subsequent encounters focused on diagnostic follow-up. Proper coding here ensures that any necessary biopsies, ultrasounds, or MRIs are justified and correctly reimbursed.
What is the ICD-10 code for breast cancer screening?
The correct code is Z12.31, used for routine screening mammograms without current symptoms or diagnoses.
Can Z12.31 be used for annual breast cancer screenings?
Yes, Z12.31 is valid for annual screenings and is often billed once every 12 months in routine preventive care.
What is the ICD-10 code for abnormal mammogram findings?
Use R92.8 to indicate abnormal or inconclusive mammogram results that need further investigation.
Is there a different code for mammogram screenings with breast implants?
The diagnosis code remains Z12.31, but additional imaging or CPT codes indicate implant-related considerations.
How is bilateral breast screening coded in ICD-10?
Z12.31 is still used, but bilateral procedures are specified using CPT or radiology modifiers, not separate ICD codes.
What ICD-10 code should be used when breast cancer is found after screening?
If breast cancer is confirmed, use the appropriate C50 series code based on tumor location, such as C50.211 or C50.912.
Are there ICD codes that differ for male vs. female breast cancer?
Yes, male and female breast cancers have separate codes based on anatomy. For example, C50.021 indicates left male nipple and areola cancer.