Diagnostic mammogram, also known as breast diagnostic imaging or mammography diagnostic, is a crucial procedure for evaluating breast abnormalities. This focused imaging technique aids in the diagnosis of breast changes detected during a screening mammogram or physical exam. Clinicians utilize diagnostic mammography for detailed breast imaging and documentation, supporting accurate medical coding and healthcare claims. Learn about diagnostic mammogram procedures, CPT codes, and the importance of this essential diagnostic tool in breast health.
Also known as
Encounter for screening mammogram for malignant neoplasm of breast
Encounter for routine screening mammogram to detect breast cancer.
Abnormal findings on diagnostic imaging of breast
Abnormal results found on breast imaging tests like mammograms or ultrasounds.
Unspecified lump in breast
A lump or mass in the breast that has not been specifically diagnosed.
Encounter for other specified special examinations
Encounter for specialized examination not otherwise classified, such as a diagnostic mammogram following abnormal screening results
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the diagnostic mammogram for screening purposes?
Yes
Do NOT code as diagnostic. Use Z12.31 (Encounter for screening mammogram for malignant neoplasm of breast).
No
Is there a personal history of breast cancer?
When to use each related code
| Description |
|---|
| Targeted breast imaging for abnormal findings. |
| Routine breast x-ray for early cancer detection. |
| Breast ultrasound uses sound waves to create images. |
Missing or incorrect laterality (right, left, bilateral) can lead to claim denials and inaccurate reporting for diagnostic mammograms.
Lack of a documented presenting symptom or problem code with a diagnostic mammogram may result in claim rejection by payers.
Incorrect coding of a screening mammogram as diagnostic, or vice versa, leads to inaccurate reimbursement and quality data.
Q: What are the key differentiating factors between a diagnostic mammogram and a screening mammogram in terms of indications and image interpretation?
A: While both diagnostic and screening mammograms utilize X-ray technology to image breast tissue, their indications and interpretation differ significantly. Screening mammograms are performed on asymptomatic women at average risk for breast cancer to detect early, pre-clinical signs of disease. Image interpretation focuses on identifying subtle abnormalities that may warrant further investigation. Diagnostic mammograms, however, are indicated for women presenting with specific breast concerns such as a palpable lump, nipple discharge, skin changes, or abnormal findings on a prior screening mammogram. Interpretation of diagnostic mammograms involves a more focused assessment of the area of concern, including additional views and techniques like spot compression or magnification views to characterize the abnormality and guide management decisions. Explore how incorporating standardized reporting and documentation can enhance communication and improve patient care in diagnostic mammography.
Q: When should I order a diagnostic mammogram following an abnormal screening mammogram finding like architectural distortion or calcifications, and what factors influence this decision?
A: The decision to recommend a diagnostic mammogram after an abnormal screening mammogram depends on the specific finding and the patient's individual risk factors. For example, while certain calcification patterns might require immediate follow-up with a diagnostic mammogram and possible biopsy, other less suspicious calcifications might warrant short-interval follow-up imaging. Similarly, architectural distortion visualized on a screening mammogram often necessitates a diagnostic mammogram with additional views to better characterize the abnormality and exclude malignancy. Factors influencing this decision include the BI-RADS assessment category assigned to the finding, patient age, breast density, and personal/family history of breast cancer. Consider implementing a clear protocol for managing abnormal screening mammogram results to ensure timely and appropriate follow-up care. Learn more about BI-RADS classification and its role in guiding clinical decision-making.
Patient presented for a diagnostic mammogram due to palpable breast lump, breast pain, nipple discharge, or abnormal findings on a screening mammogram. Patient history includes (mention relevant details such as age, family history of breast cancer, personal history of breast biopsies, hormone replacement therapy use, breast density, and date of last mammogram). Clinical breast exam findings include (describe size, location, consistency, and mobility of any palpable masses or other relevant findings such as skin changes or nipple discharge). The diagnostic mammogram was performed utilizing (specify views obtained such as craniocaudal, mediolateral oblique, and additional views like spot compression or magnification). Mammographic findings revealed (describe findings using BIRADS lexicon such as mass, asymmetry, architectural distortion, calcifications; include location, size, shape, and density of abnormalities). Impression: BIRADS category (0-6) assigned based on mammographic findings. Recommendations include (short-term follow-up, additional imaging such as ultrasound or MRI, biopsy, or referral to breast surgeon). Correlation with clinical findings is advised. Medical coding includes relevant ICD-10 codes (e.g., N63, R92.1) and CPT codes (e.g., 77065, 77066, 77067) for accurate billing and documentation. The patient was counseled regarding the results and plan of care.