ICD-10 Coding for Screening Mammography

Introduction to Screening Mammography Coding

The American College of Radiology recommends using the ICD-10 code Z12.31 for screening mammogram orders for asymptomatic patients with no symptoms, signs, or history of breast disease 1
The American College of Internal Medicine suggests that Z12.31 should be used when ordering routine screening mammograms for asymptomatic patients 2
The National Comprehensive Cancer Network indicates that the code Z12.31 signifies the purpose of the encounter is for preventive screening rather than diagnostic evaluation 3

For asymptomatic patients with no breast complaints or abnormalities, the ICD-10 code Z12.31 is used for screening mammography 3
If the patient has a personal history of breast cancer, the code Z85.3 should be used as a secondary code 1

For women aged 40 and older, annual screening mammography is recommended, and Z12.31 would be the appropriate code 1, 2
For high-risk women under 40 who qualify for screening, Z12.31 would still be the appropriate code, though additional risk factor codes may be beneficial 5
For transgender patients meeting screening criteria, Z12.31 is still the appropriate code for breast cancer screening 5

For patients with increased risk factors, consider adding appropriate secondary codes, such as Z80.3 for family history of malignant neoplasm of breast 1
For patients with genetic predisposition, the code Z84.89 may be used 1
For patients with known genetic mutations, the code Z15.01 may be used 2

Diagnostic codes, such as N60-N65 breast disorders, should not be used for screening examinations 3
The general screening code Z12.39 should not be used when the more specific Z12.31 is appropriate 1
The code Z01.89 should not be used for breast cancer screening as it is too general 2

If a screening mammogram reveals an abnormality requiring additional imaging, the subsequent visit should be coded with the appropriate diagnostic code rather than Z12.31 3
For short-interval follow-up of probably benign findings, the appropriate diagnostic code rather than the screening code should be used 6