Z12.31: Encounter for screening mammogram for malignant neoplasm of breast
Billable ICD-10-CM code, FY2027
What ICD-10-CM says
Excludes1 (never coded with Z12.31)
- inconclusive mammogram (R92.2)
What Z12.31 covers
Z12.31 is for a screening mammogram in a patient with no breast signs or symptoms. Screening means testing for disease in people who seem well, and this code says that is why the patient was seen.
Primary care, OB-GYN and imaging centers use it. Its sibling Z12.39 covers other screening for breast cancer. When a patient has a symptom such as a lump, the mammogram is diagnostic and is coded with the sign or symptom, not Z12.31.
Billing and coding notes
Z12.31 has an excludes1 for inconclusive mammogram (R92.2). If a finding is made during screening, the guidelines say the code for the finding may be added. A family history of breast cancer (Z80.3) can be added as context.
The guidelines say a screening code isn't needed when the screening is part of a routine exam. Z12.31 is for an encounter where the screening mammogram itself is the reason for the visit.
Related codes under Z12.3
Questions about Z12.31
What is the difference between a screening and a diagnostic mammogram in ICD-10-CM?
A screening mammogram is for a patient without symptoms and is coded Z12.31. A diagnostic mammogram is for a sign, symptom or earlier finding, and is coded with that sign or finding.
Can Z12.31 and R92.2 be coded together?
No. Inconclusive mammogram (R92.2) is an excludes1 at Z12.31.
ICD-10-CM in CloudMedico
In CloudMedico, a visit's diagnoses come from the current ICD-10-CM list. For US practices, the visit flags a code that isn't billable on its date, and a superbill made from an invoice carries the visit's diagnoses.
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