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v1.0.0
ICD-10 Guide
ICD-10 CodesR92.8

R92.8

Other abnormal and inconclusive findings on diagnostic imaging of breast

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

Code Description

ICD-10 R92.8 is a billable code used to indicate a diagnosis of other abnormal and inconclusive findings on diagnostic imaging of breast.

Key Diagnostic Point:

R92.8 is used to classify findings from breast imaging studies that are abnormal or inconclusive but do not fit into more specific categories. This may include vague or indeterminate results from mammograms, ultrasounds, or MRIs that do not clearly indicate malignancy or benign conditions. Common findings may include asymmetries, calcifications, or masses that require further evaluation or follow-up imaging. The clinical context often involves patients with risk factors for breast cancer or those undergoing routine screening. The ambiguity of the findings necessitates careful documentation and may lead to additional diagnostic procedures, such as biopsies or repeat imaging, to clarify the nature of the abnormality. Accurate coding is essential to ensure appropriate patient management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in imaging interpretations
  • Need for follow-up procedures
  • Potential for overlapping symptoms with other codes
  • Documentation requirements for inconclusive findings

Audit Risk Factors

  • Inadequate documentation of imaging findings
  • Failure to specify follow-up actions taken
  • Misclassification of findings as benign or malignant
  • Inconsistent coding practices among providers

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Documentation should include detailed descriptions of imaging findings, patient history, and any follow-up recommendations.

Common Clinical Scenarios

Patients presenting for routine breast screening or those with a family history of breast cancer.

Billing Considerations

Consider the patient's risk factors and previous imaging results when coding.

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with breast pain or palpable masses requiring urgent evaluation.

Billing Considerations

Ensure that the urgency of the situation is reflected in the documentation to support the use of R92.8.

Coding Guidelines

Inclusion Criteria

Use R92.8 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when findings are truly inconclusive and not clearly classified under other codes
  • Document the rationale for using R92
  • 8, including any follow
  • up plans

Exclusion Criteria

Do NOT use R92.8 When
No specific exclusions found.

Related CPT Codes

77067CPT Code

Mammography, bilateral, including computer-aided detection

Clinical Scenario

When a mammogram shows inconclusive findings, R92.8 may be used alongside this CPT code.

Documentation Requirements

Document the findings and any recommendations for follow-up imaging.

Specialty Considerations

Radiologists must ensure clarity in their reports to support the use of R92.8.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast imaging findings, improving the granularity of data for patient management and research. R92.8 provides a necessary code for those ambiguous cases that require further evaluation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast imaging findings, improving the granularity of data for patient management and research. R92.8 provides a necessary code for those ambiguous cases that require further evaluation.

Reimbursement & Billing Impact

reimbursement.

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 R92.8 be used?

R92.8 should be used when imaging findings are abnormal or inconclusive and do not fit into more specific categories. It is essential to document the findings and any follow-up actions.

What documentation is required for R92.8?

Documentation must include detailed descriptions of the imaging findings, patient history, and any recommendations for follow-up imaging or procedures.