2022 ICD-10-CM Code Z12.31
Encounter for screening mammogram for malignant neoplasm of breast
Code Classification
Z12.31 is a billable diagnosis code used to specify a medical diagnosis of encounter for screening mammogram for malignant neoplasm of breast. The code Z12.31 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 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.
The code Z12.31 is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Radiology: Inappropriate Use Of "probably Benign" Assessment Category In Screening Mammograms , Radiology: Reminder System For Screening Mammograms.
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 coding notes and 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
Entries in the Index to Diseases and Injuries with references to Z12.31
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 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code Z12.31 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
- V76.12 - Screen mammogram NEC (Approximate Flag)
Quality Payment Program Measures
When code Z12.31 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
Quality Measure | Description | Quality Domain | Measure Type | High Priority | Submission Methods |
---|---|---|---|---|---|
Radiology: Inappropriate Use of "Probably Benign" Assessment Category in Screening Mammograms | Percentage of final reports for screening mammograms that are classified as "probably benign". | Efficiency and Cost Reduction | Process | YES | Claims, Registry |
Radiology: Reminder System for Screening Mammograms | Percentage of patients undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram. | Communication and Care Coordination | Structure | YES | Claims, Registry |
Information for Patients
Health Screening
Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.
Some conditions that doctors commonly screen for include
- Breast cancer and cervical cancer in women
- Colorectal cancer
- Diabetes
- High blood pressure
- High cholesterol
- Osteoporosis
- Overweight and obesity
- Prostate cancer in men
Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them.
Agency for Healthcare Research and Quality
[Learn More in MedlinePlus]
Mammography
A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer.
Screening mammography is the type of mammogram that checks you when you have no symptoms. It can help reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn't cancer. This leads to further testing and can cause you anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes you to radiation. You should talk to your doctor about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.
Mammograms are also recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease.
When you have a mammogram, you stand in front of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture. You should get a written report of your mammogram results within 30 days.
NIH: National Cancer Institute
[Learn More in MedlinePlus]
Breast Cancer Screening (PDQ®) Learn about breast cancer screening tests used to find changes in the breast before cancer develops.
[Learn More in MedlinePlus]
Mammograms Learn what screening and diagnostic mammograms are and how findings, including breast density, are reported. This fact sheet also discusses the benefits and potential harms of screening mammography.
[Learn More in MedlinePlus]
Related Codes
ICD Code | Description | Valid for Submission |
---|---|---|
Z12 | Encounter for screening for malignant neoplasms | NON-BILLABLE CODE |
Z12.0 | Encounter for screening for malignant neoplasm of stomach | BILLABLE CODE |
Z12.1 | Encounter for screening for malignant neoplasm of intestinal tract | NON-BILLABLE CODE |
Z12.10 | Encounter for screening for malignant neoplasm of intestinal tract, unspecified | BILLABLE CODE |
Z12.11 | Encounter for screening for malignant neoplasm of colon | BILLABLE CODE |
Z12.12 | Encounter for screening for malignant neoplasm of rectum | BILLABLE CODE |
Z12.13 | Encounter for screening for malignant neoplasm of small intestine | BILLABLE CODE |
Z12.2 | Encounter for screening for malignant neoplasm of respiratory organs | BILLABLE CODE |
Z12.3 | Encounter for screening for malignant neoplasm of breast | NON-BILLABLE CODE |
Z12.39 | Encounter for other screening for malignant neoplasm of breast | BILLABLE CODE |
Z12.4 | Encounter for screening for malignant neoplasm of cervix | BILLABLE CODE |
Z12.5 | Encounter for screening for malignant neoplasm of prostate | BILLABLE CODE |
Z12.6 | Encounter for screening for malignant neoplasm of bladder | BILLABLE CODE |
Z12.7 | Encounter for screening for malignant neoplasm of other genitourinary organs | NON-BILLABLE CODE |
Z12.71 | Encounter for screening for malignant neoplasm of testis | BILLABLE CODE |
Z12.72 | Encounter for screening for malignant neoplasm of vagina | BILLABLE CODE |
Z12.73 | Encounter for screening for malignant neoplasm of ovary | BILLABLE CODE |
Z12.79 | Encounter for screening for malignant neoplasm of other genitourinary organs | BILLABLE CODE |
Z12.8 | Encounter for screening for malignant neoplasm of other sites | NON-BILLABLE CODE |
Z12.81 | Encounter for screening for malignant neoplasm of oral cavity | BILLABLE CODE |
Z12.82 | Encounter for screening for malignant neoplasm of nervous system | BILLABLE CODE |
Z12.83 | Encounter for screening for malignant neoplasm of skin | BILLABLE CODE |
Z12.89 | Encounter for screening for malignant neoplasm of other sites | BILLABLE CODE |
Z12.9 | Encounter for screening for malignant neoplasm, site unspecified | BILLABLE CODE |
Code History
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)