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v1.0.0
ICD-10 Guide
ICD-10 CodesR92

R92

Abnormal and inconclusive findings on diagnostic imaging of breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R92 is a billable code used to indicate a diagnosis of abnormal and inconclusive findings on diagnostic imaging of breast.

Key Diagnostic Point:

The ICD-10 code R92 is used to classify abnormal and inconclusive findings on diagnostic imaging of the breast, which may include mammograms, ultrasounds, or MRI scans. These findings can indicate a variety of conditions, such as benign lesions, suspicious masses, or other abnormalities that require further investigation. Common symptoms associated with these findings may include breast pain, lumps, or changes in breast shape or size. The imaging results may show calcifications, masses, or architectural distortions that are not definitively benign or malignant. It is crucial for healthcare providers to follow up with additional diagnostic procedures, such as biopsies or further imaging, to clarify the nature of the findings. Accurate coding is essential for appropriate patient management and reimbursement, as well as for tracking the incidence of breast abnormalities in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in imaging findings interpretation
  • Need for additional diagnostic procedures
  • Potential overlap with other breast-related codes
  • Documentation of clinical context and follow-up plans

Audit Risk Factors

  • Inadequate documentation of imaging findings
  • Failure to document follow-up actions taken
  • Misinterpretation of imaging results leading to incorrect coding
  • Lack of clarity on whether findings are benign or malignant

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of patient history, imaging results, and follow-up plans is essential.

Common Clinical Scenarios

Patients presenting with breast pain or palpable masses requiring imaging.

Billing Considerations

Ensure that all imaging results are clearly documented and that any recommendations for further evaluation are noted.

Emergency Medicine

Documentation Requirements

Acute care documentation must include the reason for imaging and any immediate findings.

Common Clinical Scenarios

Patients presenting with acute breast symptoms, such as sudden pain or swelling.

Billing Considerations

Document any urgent follow-up needed based on imaging results to ensure continuity of care.

Coding Guidelines

Inclusion Criteria

Use R92 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when findings are abnormal or inconclusive and that appropriate documentation supports the diagnosis

Exclusion Criteria

Do NOT use R92 When
No specific exclusions found.

Related Codes

Child Codes

22 codes
R92.0
Mammographic microcalcification found on diagnostic imaging of breast
R92.1
Mammographic calcification found on diagnostic imaging of breast
R92.2
Inconclusive mammogram
R92.3
Mammographic density found on imaging of breast
R92.30
Dense breasts, unspecified
R92.31
Mammographic fatty tissue density of breast
R92.311
Mammographic fatty tissue density, right breast
R92.312
Mammographic fatty tissue density, left breast
R92.313
Mammographic fatty tissue density, bilateral breasts
R92.32
Mammographic fibroglandular density of breast
R92.321
Mammographic fibroglandular density, right breast
R92.322
Mammographic fibroglandular density, left breast
R92.323
Mammographic fibroglandular density, bilateral breasts
R92.33
Mammographic heterogeneous density of breast
R92.331
Mammographic heterogeneous density, right breast
R92.332
Mammographic heterogeneous density, left breast
R92.333
Mammographic heterogeneous density, bilateral breasts
R92.34
Mammographic extreme density of breast
R92.341
Mammographic extreme density, right breast
R92.342
Mammographic extreme density, left breast
R92.343
Mammographic extreme density, bilateral breasts
R92.8
Other abnormal and inconclusive findings on diagnostic imaging of breast

Related CPT Codes

77067CPT Code

Mammography, bilateral, diagnostic

Clinical Scenario

Used when a patient presents with abnormal findings on a screening mammogram.

Documentation Requirements

Document the reason for the diagnostic mammogram and any findings.

Specialty Considerations

Radiology must ensure that all imaging results are communicated to the referring physician.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abnormal findings, improving the granularity of data collected for breast health and enhancing the ability to track patient outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abnormal findings, improving the granularity of data collected for breast health and enhancing the ability to track patient outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of abnormal findings, improving the granularity of data collected for breast health and enhancing the ability to track patient outcomes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should R92 be used?

R92 should be used when diagnostic imaging of the breast reveals abnormal or inconclusive findings that require further evaluation but are not definitively diagnosed as malignant.