High risk breast cancer screening icd 10

Mammography is the process of using low-energy X-rays  to examine the human breast, which is used as a diagnostic and screening tool. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications.

The ICD-9-CM codes used for mammograms for so long, like V76.12, will be going away. However, the diagnosis coding guidelines for mammograms have not changed  so the coding should be easy in ICD-10-CM.

Screening Mammograms

In ICD-10, a screening code will be assigned as the primary diagnosis for a screening mammogram. However, there wont be  two screening codes to choose from.  ICD-10-CM does not distinguish between low-risk patients (V76.12) and high-risk patients (V76.11). All screening mammograms should be reported with ICD-10-CM code Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast). Any relevant clinical history or clinical findings as a secondary diagnosis should be coded. For example, if the patient has a family history of breast cancer, her screening mammogram claim with code Z12.31 followed by code Z80.3 (Family history of malignant neoplasm of breast) will be coded.

Diagnostic Mammograms

A diagnostic mammogram should not be submitted with the screening code, Z12.31. Instead the following points should be taken into consideration while coding:

• The radiologist’s definitive findings or,
• If the exam is normal or inconclusive,
• The signs or symptoms that prompted the physician to order a diagnostic mammogram should be coded.
• For example, a patient is referred for a diagnostic mammogram due to calcifications seen on her screening mammogram. The radiologist documents that the calcifications are most likely vascular in nature, and he recommends the patient continue routine annual screening mammograms. The diagnosis code for this encounter would be R92.1 (Mammographic calcification found on diagnostic imaging of breast).

Mammographic Finding

The codes can be located in the ICD-10-CM Index for any mammographic findings. In ICD-10-CM, both breast mass and breast nodule are reported with the same code, N63 (Unspecified lump in breast) unlike ICD-9-CM, which uses code 793.89 for breast nodule and code 611.72 for breast mass.

ICD-10-CM code R92.1 (Mammographic calcification found on diagnostic imaging of breast) is reported for calcifications seen on mammograms. Smaller calcium deposits, which are more likely to be associated with breast cancer, are called microcalcifications. Code R92.0 is reported for Microcalcifications which is indexed under “Microcalcification, mammographic.”

Inconclusive Mammogram

Mammography is less effective in detecting cancer when the patient’s breast tissue is dense. Code R92.2 (Inconclusive mammogram) is used to report dense breasts which can also be used for mammograms that are inconclusive for other reasons.There is an Excludes1 note under code R92.2 which indicates that R92.2 may not be reported together with the screening mammogram code, Z12.31. Therefore R92.2 should only be assigned to a diagnostic mammogram.

Breast Implants

Code Z98.82 (Breast implant status) should be assigned for patients who have breast implants without complications. Z12.31 should be reported as the primary diagnosis for a screening mammogram and Z98.82 as a secondary diagnosis. On the other hand, Z98.82 may also be used to report the primary diagnosis if the physician orders a diagnostic mammogram due to the presence of implants.

Code Z98.86 (Personal history of breast implant removal) is reported if the patient previously had breast implants but they have been removed. If the patient is experiencing complications from the implants, a complication code should be reported. A patient is referred for a diagnostic mammogram if there has been a change in the shape of her left breast and the treating physician suspects rupture of her breast implant.  If diagnostic mammography confirms a ruptured implant the correct code assigned for this example is T85.49XA (Other mechanical complication of breast prosthesis and implant, initial encounter). The only code reported is the complication code.

Mammogram