Screening Mammogram ICD-10-CM Codes | 2023

What ICD-10 Codes are Used for Screening Mammogram?

Screening mammograms play a crucial role in early detection of breast cancer. Accurate coding using the International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) is vital for proper documentation and billing. Here are some commonly used ICD-10-CM codes for screening mammograms, 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 screening mammogram due to a known or suspected malignant neoplasm (cancer) of the breast.

Z12.39 - Encounter for screening mammogram for other conditions

This code is utilized when a patient undergoes a screening mammogram for reasons other than a known or suspected malignant neoplasm. It includes screening for various breast conditions and routine preventive care.

Z80.3 - Family history of malignant neoplasm of breast

This code is assigned when a patient has a family history of breast cancer, and a screening mammogram is conducted to assess the risk and detect any abnormalities.

Z85.3 - Personal history of malignant neoplasm of breast

When a patient has a personal history of breast cancer and undergoes a screening mammogram for surveillance and early detection of any recurrence or new malignancies, this code is applied.

Z12.4 - Encounter for screening for malignant neoplasm of cervix

Although not directly related to breast cancer, this code is included as screening mammograms may be conducted simultaneously with cervical cancer screenings.

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

This code is used when a patient undergoes a screening mammogram to detect malignancies other than breast or cervical cancer, such as ovarian or uterine cancer.

Z01.411 - Encounter for gynecological examination (general) (routine) with abnormal findings

This code is applied when an abnormality is detected during a routine gynecological examination, and a screening mammogram is ordered to investigate the breast further.

Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings

This code is used when a patient undergoes a routine gynecological examination without any abnormal findings and a screening mammogram is performed as part of preventive care.

Z01.810 - Encounter for preprocedural cardiovascular examination

This code is assigned when a cardiovascular examination is conducted prior to certain procedures or surgeries, and a screening mammogram is performed as part of the overall preoperative evaluation.

Z01.818 - Encounter for other preprocedural examination

This code is used when a preprocedural examination is conducted for purposes other than cardiovascular evaluation and a screening mammogram is performed as part of the preoperative assessment.

Which Screening Mammogram ICD codes are Billable: 

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

Yes, this code is billable as it indicates that the mammogram is for screening purposes related to known or suspected breast cancer.

Z12.39 - Encounter for screening mammogram for other conditions

Yes, this code is billable as it covers screening mammograms for conditions other than breast cancer, ensuring appropriate reimbursement.

Z80.3 - Family history of malignant neoplasm of breast

Yes, this code is billable as it signifies that the screening mammogram is performed due to a documented family history of breast cancer, which justifies the need for surveillance.

Z85.3 - Personal history of malignant neoplasm of breast

Yes, this code is billable as it indicates that the patient has a personal history of breast cancer, warranting ongoing monitoring through screening mammograms.

Z12.4 - Encounter for screening for malignant neoplasm of cervix

Yes, this code is billable for the cervical cancer screening component of the encounter. However, it may not cover the cost of the screening mammogram, which may require a separate billable code.

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

Yes, this code is billable as it encompasses screening mammograms for other specified malignancies, such as ovarian or uterine cancer, indicating the need for appropriate reimbursement.

Z01.411 - Encounter for gynecological examination (general) (routine) with abnormal findings

Yes, this code is billable as it represents an encounter where an abnormality is found during a routine gynecological examination, leading to the need for a screening mammogram.

Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings

This code is generally only billable for a routine gynecological examination with abnormal findings. However, using an appropriate code, the screening mammogram component may still be billable.

Z01.810 - Encounter for preprocedural cardiovascular examination

No, this code is not billable solely for the preprocedural cardiovascular examination. However, an additional billable code should be used if a screening mammogram is performed as part of the overall preoperative evaluation.

Z01.818 - Encounter for other preprocedural examination

No, this code is not billable solely for other preprocedural examinations. Similar to Z01.810, an appropriate billable code should be utilized if a screening mammogram is conducted as part of the preoperative assessment.

Clinical Information

• Family History: ICD-10 codes such as Z80.3 (Family history of malignant neoplasm of breast) indicate that the patient has a family history of breast cancer. This information helps identify individuals at higher risk and emphasizes the importance of regular screening.
• Personal History: ICD-10 code Z85.3 (Personal history of malignant neoplasm of breast) indicates a previous breast cancer diagnosis. This history guides the need for ongoing surveillance to detect recurrence or new malignancies.
• Other Conditions: ICD-10 code Z12.39 (Encounter for screening mammograms for other conditions) covers screening mammograms performed for various breast conditions, not limited to cancer. It encompasses routine preventive care and aids in the early detection and management of non-cancerous abnormalities.
• Abnormal Findings: Codes such as Z01.411 (Encounter for gynecological examination with abnormal findings) are used when an abnormality is detected during a routine gynecological examination, prompting a screening mammogram to investigate the breast further.
• Cervical Cancer Screening: While not directly related to breast cancer, ICD-10 code Z12.4 (Encounter for screening for malignant neoplasm of the cervix) indicates simultaneous screening for cervical cancer and provides comprehensive preventive care for women.
• Other Malignancies: ICD-10 code Z12.89 (Encounter for screening for other specified malignant neoplasms) encompasses screening mammograms for malignancies other than breast or cervical cancer. It highlights the importance of comprehensive cancer screening for individuals at risk of specific malignancies.

Understanding the clinical information associated with mammogram screening ICDs helps healthcare providers interpret the purpose of the screening and tailor patient care accordingly. It assists in risk assessment, early detection of abnormalities, and appropriate management, ultimately improving patient outcomes.

‍Synonyms Include:

• Mammography screening
• Breast cancer screening
• Breast imaging screening
• Routine mammogram
• Preventive mammogram