RMC’s AHIMA Approved ICD-10 Trainers meet multiple times per week fielding questions from clients and staff. Below is an actual question that was submitted, along with our team’s response. *
CODING QUESTION: “We have encountered an insurance denying a claim with code R92.8 other abnormal and inconclusive findings on diagnostic imaging of breast. We are kinda confused on why, but maybe it’s just the insurance this person has. So as we started talking we discovered a few things.
We weren’t aware that we shouldn’t be coding R92.2 inconclusive mammo with a screening code. So our first question is…. What do we do when the screening really is inconclusive because of dense breasts so they schedule the patient to come back for a follow-up? I was always taught that we were supposed to code everything they find on a screening.”
RMC RESPONSE: If the pt comes in for screening- only code Z12.31- Screening mammo for malignant neoplasm. If finding of dense breasts on the screening then referencing coding clinic (below) and excludes 1 note under the Zcode (excludes R92.2), do not code R92.2- Dense breasts. Correct coding would be Z12.31. **Note this may be a change from what you coded in ICD9, due to the presence of Coding Clinic below and the excludes 1 note.**
Reference: Coding Clinic, First Quarter 2015: Page 24
Coding advice or code assignments contained in this issue effective with discharges March 16, 2015.
Question: What is the correct ICD-10-CM diagnosis code assignment for an encounter for a screening mammogram, when the patient is found to have dense breasts? The ICD-10-CM Official Guidelines for Coding and Reporting, Section I, C, 21, c, 5, clarifies that a screening code is the first listed code if the reason for the visit is specifically the screening exam. If a condition is discovered during the screening then the code for the condition may be assigned as an additional diagnosis. Should code R92.2, Inconclusive mammogram, be assigned as an additional diagnosis when dense breasts are documented?
Answer: For the initial screening mammogram, assign only code Z12.31, Encounter for screening mammogram for malignant neoplasm. Code R92.2, Inconclusive mammogram, would be assigned for the follow-up encounter to describe the reason for further testing. The intent of code R92.2 is to describe the reason for the subsequent encounter.
Let us know your thoughts! We want YOU to join the conversation!*
* Every effort has been made to answer these questions to the best of RMC’s abilities, at the time the original question was submitted. Answers should not be considered official coding advice, and we always encourage conversation and dialogue regarding our responses. As best practice policy, always be sure to refer to your Official Coding Guidelines, Coding Clinic, CPT Assistant, etc.