ICD-10 Guide

Abnormal Mammogram Findings

ICD-10 Coding for Abnormal Mammogram Findings(R92.0, R92.2, 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 Findings?

Abnormal mammogram findings refer to results from a mammogram that indicate potential breast abnormalities, necessitating further evaluation. Key clinical points include: 1) Abnormal findings may suggest the presence of benign or malignant lesions. 2) Follow-up imaging or biopsies are often required to determine the nature of the findings. 3) Risk factors for abnormal findings include age, family history, and genetic predispositions. Typical use cases for this diagnosis code include routine screening mammograms that yield suspicious results, diagnostic mammograms following clinical breast examinations, and assessments for patients with a history of breast cancer. Etiologically, abnormal findings can arise from various conditions, including fibrocystic changes, calcifications, or tumors. Clinically, patients may present with no symptoms, or they may report breast pain, palpable masses, or changes in breast appearance. Accurate coding is essential for appropriate management and reimbursement.

Key Clinical Considerations:

Abnormal mammogram findings require confirmation through additional imaging or biopsy.
Signs may include asymmetry, masses, or calcifications noted on the mammogram.
Resolution criteria include negative follow-up imaging or benign biopsy results.
Imaging findings such as BI-RADS categories 0, 3, 4, or 5 indicate the need for further evaluation.

Clinical Information

Clinical Criteria & Documentation Requirements

Documentation must include the reason for the mammogram, findings, and recommendations for follow-up.
Compliant documentation includes clear descriptions of findings and any patient history relevant to the diagnosis.
Example of compliant documentation: 'Mammogram shows irregular mass in the upper outer quadrant of the left breast.' Non-compliant would be vague statements like 'mammogram abnormal.'
Medical necessity documentation should justify the need for the mammogram based on patient risk factors or symptoms.

Coding Guidelines

Usage Guidelines & Examples

Use R92.0 for abnormal mammogram findings without further specification, R92.2 for findings that are inconclusive, and R92.8 for other abnormal findings.
Do not use these codes for routine screening mammograms that yield normal results.
Correct usage example: 'Patient with abnormal mammogram showing calcifications coded as R92.0.' Incorrect usage: 'Patient with normal mammogram coded as R92.0.'
Common errors include misclassifying the type of abnormality or failing to document the reason for the mammogram.

Code Exclusions

Important Exclusions

Excluded conditions include normal mammogram results, which do not require coding under these categories.
Alternative codes for exclusions may include Z12.31 for screening mammogram results.
Common exclusion errors include coding abnormal findings when the mammogram is normal; corrective action involves verifying the report.
Certain conditions are excluded to avoid misrepresentation of patient status and ensure accurate billing.

Specialty Focus

Primary Specialty

Radiology

Specialty Applications

This diagnosis applies to women undergoing routine screening or diagnostic mammograms.
Appropriate clinical scenarios include patients with palpable breast masses or abnormal clinical breast exams.
Applicable in both outpatient settings for routine screenings and inpatient settings for diagnostic evaluations.
Specialty-specific considerations include the need for radiologists to provide detailed reports on findings.

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 findings diagnosed based on imaging results.'

Template 2

Template: 'Patient presents with breast pain and abnormal mammogram findings consistent with R92.0.'

Template 3

Template: 'Diagnostic criteria met: irregular mass noted on mammogram.'

Template 4

Template: 'Treatment plan includes follow-up imaging and possible biopsy for abnormal 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 should include the reason for the mammogram, findings, and any follow-up recommendations.

When should this code be used vs similar codes?

Use R92.0 for unspecified findings, R92.2 for inconclusive results, and R92.8 for other specified abnormalities.

What are common billing issues with this code?

Common issues include denials for lack of medical necessity; ensure thorough documentation of risk factors.

What procedures are commonly associated?

Related CPT codes include 77067 for diagnostic mammography and 19120 for breast biopsy.

What is Abnormal Mammogram Findings?

Key Clinical Considerations:

Abnormal mammogram findings require confirmation through additional imaging or biopsy.
Signs may include asymmetry, masses, or calcifications noted on the mammogram.
Resolution criteria include negative follow-up imaging or benign biopsy results.
Imaging findings such as BI-RADS categories 0, 3, 4, or 5 indicate the need for further evaluation.

Abnormal Mammogram Findings

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 Findings

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?