Wiki use of Z12.31

[mnuhfer04]

Hi all,

As a PCP office, I had been told that when the provider gives a referral for a screening mammogram that we are to put Z12.31 on the claim for that visit. But the guidelines state that Z12.31 is to be used with a procedure code. We aren't doing the mammogram in office, just referring the patient for one. So, is putting Z12.31 on the claim incorrect?

Thanks!

 

[CBLENNIE]

What was the reason for the office visit that you are assigning this diagnosis to? Since you are not doing the mammogram, you should not be using Z12.31 because it indicates that the mammogram is planned to be performed by your provider, but you aren't doing them in house you are referring them out. So Z12.31 would go on the physician's order/referral for the mammogram but not on the claim for the physician's office visit during which the screening mammogram was ordered.

 

[mnuhfer04]

What was the reason for the office visit that you are assigning this diagnosis to? Since you are not doing the mammogram, you should not be using Z12.31 because it indicates that the mammogram is planned to be performed by your provider, but you aren't doing them in house you are referring them out. So Z12.31 would go on the physician's order/referral for the mammogram but not on the claim for the physician's office visit during which the screening mammogram was ordered.

This was more of a general question, not really related to a particular visit. We are a primary care office and when a patient is due for a mammogram, the providers give a referral. That is never the only reason for the visit.

 

[mnuhfer04]

Hi Mnuhfer04,
I would not use dx Z12.31 as first dx code. It is fine as 2nd dx code NOT first. also another 2nd dx is Z01.89 Why is the provider wanting to check out the patient's mammary glands?? I d use a better dx as R92.2 if mammogram results are strange. You cannot use these 2 dx together though;Z12.31 and R92. However here are a few but documentation must support it of course...
.Any lumps felt in the breast N63 ,
Leakage of orbs but not prego N64.52 & R89,
Mastitis from breastfeeding dx N61,
Reconstructed breast dx N65,
Hydro - super large breasts N62,or DASA breast condition dx N60.3,
Disorders of breast N64.5 or Signs & symptoms in breast dx N64.59. You may want to use one of these as 1st dx too search for any breast problems
Breast graft infection see dxT85.898. Also ck out T86 or T83 dx blocks linked to breast surgery malfunctions
Well I hope these tips help you. Have a good day & good luck!
Lady T

Thank you! I don't ever use it as a first dx code, as it is never the reason for the visit. But when the providers see that it is time for the patient to get an updated mammogram, its documented in the note and a referral is given. I was just a bit confused if I should include Z12.31 on the claim since the guidelines state to use certain Z codes with a procedure code and doesn't mention an E/M code.

 

[skneefel]

What was the reason for the office visit that you are assigning this diagnosis to? Since you are not doing the mammogram, you should not be using Z12.31 because it indicates that the mammogram is planned to be performed by your provider, but you aren't doing them in house you are referring them out. So Z12.31 would go on the physician's order/referral for the mammogram but not on the claim for the physician's office visit during which the screening mammogram was ordered.

Do you have an official source that can be referenced on an audit that supports this information?

So Z12.31 would go on the physician's order/referral for the mammogram but not on the claim for the physician's office visit during which the screening mammogram was ordered.)

I need something to use to show my provider's when I audit them.

 

[TThivierge]

Hi Mnuhfer04,
I would not use dx Z12.31 as first dx code. It is fine as 2nd dx code NOT first. also another 2nd dx is Z01.89 Why is the provider wanting to check out the patient's mammary glands?? I d use a better dx as R92.2 if mammogram results are strange. You cannot use these 2 dx together though;Z12.31 and R92. However here are a few but documentation must support it of course...
.Any lumps felt in the breast N63 ,
Leakage of orbs but not prego N64.52 & R89,
Mastitis from breastfeeding dx N61,
Reconstructed breast dx N65,
Hydro - super large breasts N62,or DASA breast condition dx N60.3,
Disorders of breast N64.5 or Signs & symptoms in breast dx N64.59. You may want to use one of these as 1st dx too search for any breast problems
Breast graft infection see dxT85.898. Also ck out T86 or T83 dx blocks linked to breast surgery malfunctions
Well I hope these tips help you. Have a good day & good luck!
Lady T