October is Breast Cancer Awareness Month: What better time than now to buff up your cancer documentation and reporting?!

According to the World Health Organization (WHO), breast cancer is the most common cancer globally (as of 2021) and the second most fatal cancer in women. We encourage those that fall within the screening guidelines to get your mammogram scheduled today.  

In order to assure appropriate coding for these conditions, it is critical to recognize causes, stages and symptoms of different types of cancer and documenting them properly. Accurate coding that symbolizes the patient’s current acuity helps to provide appropriate care that the patient requires.  

According to the American Cancer Society (ACS), breast cancer screening recommendations include:  

• Women between 40-44 years have the choice to start screening
• Women between 45-54 years should be screened yearly
• Women between 55-75 years should have a mammogram once every 2 years
• Women 75 and older (with average risk and life expectancy of 10+years) should continue regularly scheduled screenings 

Tip: When considering ICD10 reporting, the reason for the encounter should be sequenced first and the appropriate person and/or history code(s) should be assigned as additional diagnos(es).  

Report screening code Z12.31 for routine mammograms that present without symptoms.  

ICD10CM Codes* 

Z12.31   Encounter for screening mammogram of malignant neoplasm of the breast  

Z17.0     Estrogen receptor positive status {ER+} 

Z17.1    Estrogen receptor negative status {ER-} 

Z80.3     Family history of primary malignant neoplasm of breast (conditions classifiable to C50.-) 

Z85.3     Personal history of malignant neoplasm of breast (conditions classifiable to C50.-) 

 
C50.XXX malignant neoplasm of the breast  

Codes in this category identify laterality, gender, area of breast. See ICD10CM for details* 

Use additional code to identify estrogen receptor status (Z17.0, Z17.1) 

CPT/HCPCS Service Codes* 

It is our goal at BCA to generate awareness about the risks of breast cancer and benefits of early detection while encouraging excellent documentation and coding to tell our stories well. 
 

*See AMA’s CPT Professional Edition 2021 and ICD10CM 2022 for additional details.