Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast, is the primary diagnosis code assigned for a screening mammogram. If the mammogram is diagnostic, the ICD-10-CM code assigned is the reason the diagnostic mammogram was performed.
Specifically, according to cms.org, CMS instructs that mammography be described using the following codes: G0202, Screening mammography, bilateral (two-view study of each breast), including CAD when performed. G0204, Diagnostic mammography, including CAD when performed; bilateral.
Group 1CodeDescription77065DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL77066DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL16 more rows
Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is reported for screening mammograms while Z12. 39 (Encounter for other screening for malignant neoplasm of breast) has been established for reporting screening studies for breast cancer outside the scope of mammograms.
Diagnostic mammograms are used for women who have symptoms such as a lump, pain, nipple thickening or discharge, or whose breasts have changed shape or size. Providers also use these to evaluate abnormalities detected in a screening mammogram.
Screening mammograms are annual preventive exams, while a doctor may order a diagnostic mammogram based on any signs of breast cancer symptoms. A diagnostic mammogram is more detailed than a screening mammogram. A screening mammogram only takes about 10 to 20 minutes, while a diagnostic mammogram can be longer.
CPT code 77063 (screening digital breast tomosynthesis) should be listed separately in addition to code from primary procedure 77067. HCPCS code G0279 (diagnostic digital breast tomosynthesis) should be listed separately in addition to the primary service mammogram code 77066 or 77065.
CPT code 77063 is an add-on code describing screening digital tomosynthesis for mammography. This procedure requires performance of a screening mammography producing direct digital images. Beginning calendar year 2018 CPT code 77063 may be reported with CPT code 77067. (HCPCS code G0202 was deleted January 1, 2018.)
2022 ICD-10-CM Diagnosis Code R92. 2: Inconclusive mammogram.
A screening colonoscopy should be reported with the following International Classification of Diseases, 10th edition (ICD-10) codes: Z12. 11: Encounter for screening for malignant neoplasm of the colon.
For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient.
The proper diagnosis code to report would be Z12. 31, Encounter for screening mammogram for malignant neoplasm of breast. The Medicare deductible and co-pay/coinsurance are waived for this service.