Valid for Submission
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 2021 from October 01, 2020 through September 30, 2021 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 ExcludesType 1 Excludes
A 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:
- - Screening (for) - Z13.9
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:
Present on Admission (POA)
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.
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
Also called: Screening tests
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
- High blood pressure
- High cholesterol
- 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]
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
- Mammogram - calcifications (Medical Encyclopedia)
- Mammograms (Food and Drug Administration)
- Mammography (Medical Encyclopedia)
[Learn More in MedlinePlus]