ICD-10 Guide

Abnormal Mammogram

ICD-10 Coding for Abnormal Mammogram(R92.0, R92.1, R92.2, R92.3, R92.8)

PRIMARY SPECIALTYRadiology

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Abnormal Mammogram?

An abnormal mammogram indicates that a screening or diagnostic mammogram has revealed findings that require further evaluation. Key clinical points include: 1) Abnormal mammograms can indicate benign or malignant conditions; 2) Follow-up imaging or biopsy may be necessary; 3) Risk factors for breast cancer include age, family history, and genetic predispositions. Etiologically, abnormal mammograms may arise from various breast conditions, including fibrocystic changes, calcifications, or tumors. Pathophysiologically, these findings can result from cellular changes in breast tissue. Clinically, patients may present asymptomatically, or with symptoms such as breast pain or palpable masses. Typical use cases for this diagnosis code include follow-up assessments after routine screenings or in patients with a history of breast abnormalities.

Key Clinical Considerations:

An abnormal mammogram is diagnosed based on imaging findings that deviate from normal breast architecture.
Signs may include microcalcifications, masses, or asymmetries detected on mammography.
Resolution criteria involve the absence of abnormal findings on follow-up imaging or biopsy results indicating benign conditions.
Imaging findings supporting diagnosis include specific patterns of calcifications or masses that warrant further investigation.

Clinical Information

Clinical Criteria & Documentation Requirements

Essential documentation includes detailed descriptions of mammogram findings, patient history, and any follow-up recommendations.
Compliant documentation: 'Mammogram shows irregular mass in the left breast; recommend ultrasound.' Non-compliant: 'Mammogram abnormal.'
Documentation template phrases: 'Mammogram findings indicate [specific abnormality].' 'Patient has a history of [relevant conditions].'
Medical necessity documentation requires justification for the mammogram based on risk factors or symptoms.

Coding Guidelines

Usage Guidelines & Examples

Use this code when a mammogram shows findings that require further evaluation, such as a suspicious mass.
Do NOT use this code when the mammogram is normal or when findings are unrelated to breast pathology.
Correct usage example: 'Abnormal mammogram with findings of a mass.' Incorrect: 'Routine screening mammogram.'
Common coding errors include using this code for routine screenings without abnormal findings; ensure clinical justification.

Code Exclusions

Important Exclusions

Excluded conditions include benign breast conditions that do not require further evaluation, such as simple cysts.
Alternative codes for exclusions include N60.1 (Fibroadenoma of breast) or N61.0 (Abscess of breast).
Common exclusion errors involve misclassifying benign findings as abnormal; ensure clarity in documentation.
Certain conditions are excluded to prevent overcoding and ensure accurate representation of patient status.

Specialty Focus

Primary Specialty

Radiology

Specialty Applications

This diagnosis applies to patients undergoing routine screening or diagnostic mammograms with abnormal findings.
Clinical scenarios include follow-up imaging for patients with a family history of breast cancer or previous abnormal results.
Applicable in outpatient settings primarily, but may also be relevant in inpatient evaluations.
Specialty-specific considerations include the need for comprehensive documentation in oncology and radiology practices.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Abnormal mammogram diagnosed based on findings of [specific abnormality].'

Template 2

Template: 'Patient presents with [symptoms] consistent with abnormal mammogram findings.'

Template 3

Template: 'Diagnostic criteria met: [specific imaging findings].'

Template 4

Template: 'Treatment plan includes [interventions] for abnormal mammogram findings.'

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this code?

Detailed documentation of mammogram findings, patient history, and follow-up recommendations.

When should this code be used vs similar codes?

Use this code for abnormal findings requiring further evaluation; similar codes apply to specific conditions.

What are common billing issues with this code?

Reimbursement may be denied if documentation does not support medical necessity; ensure thorough records.

What procedures are commonly associated?

Related CPT codes include 77067 (Diagnostic mammography) and 19281 (Breast biopsy).

What is Abnormal Mammogram?

Key Clinical Considerations:

An abnormal mammogram is diagnosed based on imaging findings that deviate from normal breast architecture.
Signs may include microcalcifications, masses, or asymmetries detected on mammography.
Resolution criteria involve the absence of abnormal findings on follow-up imaging or biopsy results indicating benign conditions.
Imaging findings supporting diagnosis include specific patterns of calcifications or masses that warrant further investigation.

Abnormal Mammogram

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?

Abnormal Mammogram

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?