Screening For Breast Cancer ICD-10-CM Codes | 2023

What ICD-10 Codes are Used for Screening For Breast Cancer?

Breast cancer screening is a crucial component of early detection and prevention efforts. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) provides specific codes for documenting and coding breast cancer screening procedures. These codes allow healthcare professionals to report and track these essential screenings accurately. Here are some commonly used ICD-10-CM codes for breast cancer screening, along with their clinical descriptions:

Z12.31 - Encounter for screening mammogram for malignant neoplasm of breast

This code is used when a patient undergoes a mammogram specifically for breast cancer screening. It helps identify the purpose of the encounter and indicates that the procedure was performed to detect any potential malignant breast neoplasms.

Z80.3 - Family history of malignant neoplasm of breast

This code is used when a patient has a documented family history of breast cancer. It highlights the significance of genetic predisposition and assists in assessing the patient's risk factors for developing breast cancer.

Z85.3 - Personal history of malignant neoplasm of breast

This code is assigned when a patient has a history of breast cancer. It is an important indicator for follow-up care, monitoring, and surveillance in individuals previously diagnosed with breast cancer.

Z12.39 - Encounter for other screening for malignant neoplasm of breast

This code is used for breast cancer screening procedures other than mammography, such as breast magnetic resonance imaging (MRI) or breast ultrasound. It provides a broader scope for reporting various screening methods.

‍Z01.81 - Encounter for preprocedural laboratory examination

This code is used when a patient undergoes laboratory tests to prepare for a breast cancer screening procedure. It ensures accurate documentation of the pre-procedural assessment required for the screening process.

Z12.89 - Encounter for screening for other specified malignant neoplasm

While not specific to breast cancer, this code can be used when a patient undergoes screening for a malignant neoplasm other than breast cancer. It allows for appropriate reporting of screenings for different types of cancers.

These ICD-10-CM codes for breast cancer screening facilitate efficient reporting and coding, ensuring proper documentation of screening procedures and contributing to accurate statistical analysis and research on breast cancer detection and prevention. Healthcare providers need to assign the appropriate code based on the specific nature of the encounter to support effective healthcare management and surveillance.

Which Screening For Breast Cancer ICD codes are Billable: 

Z12.31 - Encounter for screening mammogram for malignant neoplasm of breast

Yes, this code is billable. It specifically indicates that the mammogram was performed for breast cancer screening purposes, allowing healthcare providers to bill for the screening procedure.

Z80.3 - Family history of malignant neoplasm of the breast

No, this code is not billable on its own. It represents a patient's family history of breast cancer and is used for documentation and risk assessment purposes rather than billing for a specific screening procedure.

Z85.3 - Personal history of malignant neoplasm of the breast

No, this code is not billable for breast cancer screening. It signifies a patient's history of breast cancer, serving as an essential clinical detail for follow-up care and monitoring but not as a billable code for a screening procedure.

Z12.39 - Encounter for other screening for malignant neoplasm of breast

Yes, this code is billable. It covers screenings for breast cancer using methods other than mammography, such as breast MRI or ultrasound. Providers can bill for the specific screening procedure performed.

Z01.81 - Encounter for preprocedural laboratory examination:

No, this code is not billable for breast cancer screening. It represents a pre-procedural laboratory examination but does not directly correspond to the screening. Providers can bill for the laboratory tests separately if applicable.

Z12.89 - Encounter for screening for other specified malignant neoplasm

No, this code is not billable for breast cancer screening. It is used for screenings related to other specified malignant neoplasms, not specifically breast cancer. Providers should use specific breast cancer screening codes for accurate billing.

Clinical Information

• Screening for breast cancer is a critical aspect of early detection and prevention efforts, allowing for timely diagnosis and treatment.
• The ICD-10-CM codes for breast cancer screening provide a standardized system for documenting and coding these procedures.
• One commonly used code is Z12.31, which indicates an encounter specifically for a screening mammogram for a malignant neoplasm of the breast. This code helps identify the purpose of the encounter and highlights the use of mammography for breast cancer screening.
• Another relevant code is Z80.3, which denotes a family history of malignant neoplasm of the breast. This code is important for identifying individuals with a higher risk of developing breast cancer due to genetic factors.
• The code Z85.3 represents a personal history of malignant neoplasm of the breast, indicating that the patient has a history of breast cancer. This information is crucial for ongoing monitoring and surveillance.
• For screenings performed through methods other than mammography, the code Z12.39 can be used. This code encompasses encounters for other screening methods like breast MRI or ultrasound.
• Additional codes include Z01.81 for preprocedural laboratory examinations related to breast cancer screening and Z12.89 for screenings of other specified malignant neoplasms (not limited to breast cancer).
• Proper documentation and coding using these ICD-10-CM codes are essential for accurate reporting, statistical analysis, and breast cancer detection and prevention research.
• These codes assist healthcare providers in identifying the purpose of the encounter, assessing risk factors, tracking patient history, and determining the appropriate billing for breast cancer screening services.
• Healthcare professionals must stay updated with coding guidelines and adhere to specific payer requirements to ensure accurate documentation and coding for breast cancer screening procedures.

Synonyms Include:

• Screening for breast carcinoma
• Breast neoplasm screening
• Mammographic screening for breast cancer
• Early detection of breast cancer
• Breast cancer surveillance