Resolved Z12.39

[MistyR_46049]

When would it be appropriate to use code Z12.39? I been having coders apply this on the DX mammograms when they are coming in for follow-up from a previous screening, and also they are applying it to the MRI breast 77049 for just high risk. Wanting to know if you have any examples as these codes are being denied but need a good resource to site. Thanks!

 

[Darcy]

Screening is testing that is performed to determine whether an otherwise healthy individual (with no signs or symptoms of the particular illness or disease being screened for) tests positive for the condition, disease, or precursor to a disease or illness so that early detection and appropriate intervention can be provided when the screening results are positive.

If testing is performed to rule out or confirm a suspected diagnosis (meaning the patient presents with signs or symptoms indicating there may be a condition or illness for which testing test is ordered to rule out or confirm) this is considered diagnostic testing (not screening) and should be reported using the symptom codes rather than these screening codes.

Screening tests that result in a positive finding (in an asymptomatic patient) should be reported with the screening code along with a code for the confirmed diagnosis.

LCD - Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (L33585)

Use this page to view details for the Local Coverage Determination for Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography.

www.cms.gov

 

[MistyR_46049]

So high risk screening when they found breast densities R92.2 then get a diagnostic mammo and a MRI breast they are then using the Z12.39. Which does not seem appropriate thanks!

 

[Lori]

Z12.39 (MRI)

Encounter for other screening for malignant neoplasm of breast

Approximate Synonyms

• Screening breast exam done
• Screening exam for breast cancer
• Screening for breast cancer
• Screening for breast cancer done

Z12.31 Encounter for screening mammogram for malignant neoplasm of breast (Mammogram)

Approximate Synonyms

• Screening mammogram for breast cancer
• Screening mammogram for breast cancer done
• Screening mammogram for breast cancer in high risk patient with family history of breast cancer done
• Screening mammogram for breast cancer, high risk with family history of cancer

Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

Article - Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (A56448)

Use this page to view details for the Local Coverage Article for billing and coding: breast imaging mammography/breast echography (sonography)/breast mri/ductography.

www.cms.gov