Valid for Submission
Z12.31 is a billable code used to specify a medical diagnosis of encounter for screening mammogram for malignant neoplasm of breast. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
The code Z12.31 describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.
| ICD-10: | Z12.31 |
| Short Description: | Encntr screen mammogram for malignant neoplasm of breast |
| Long Description: | Encounter for screening mammogram for malignant neoplasm of breast |
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code Z12.31:
Type 1 Excludes
Type 1 ExcludesA type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- inconclusive mammogram R92.2
Index to Diseases and Injuries
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Z12.31 are found in the index:
- - Mammogram (examination) - Z12.39
- - routine - Z12.31
- - Screening (for) - Z13.9
- - neoplasm (malignant) (of) - Z12.9
- - breast - Z12.39
- - routine mammogram - Z12.31
- - breast - Z12.39
- - neoplasm (malignant) (of) - Z12.9
- - X-ray (of)
- - breast (mammogram) (routine) - Z12.31
Code Edits
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:
- Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.
Present on Admission (POA)
Z12.31 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .
CMS POA Indicator Options and Definitions
| POA Indicator Code | POA Reason for Code | CMS will pay the CC/MCC DRG? |
|---|---|---|
| Y | Diagnosis was present at time of inpatient admission. | YES |
| N | Diagnosis was not present at time of inpatient admission. | NO |
| U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
| W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
| 1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert Z12.31 to ICD-9
- V76.12 - Screen mammogram NEC (Approximate Flag)
Code Classification
Code History
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
(First year ICD-10-CM implemented into the HIPAA code set) - FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020