Z12.31 — Encounter for screening mammogram for malignant neoplasm of breast
Is Z12.31 billable?
Yes — Z12.31 is billable for FY2027. Z12.31 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. Z12.31 may be submitted for encounters from October 1, 2026 through September 30, 2027.
Z12.31 at a glance
| Code | Z12.31 |
|---|---|
| Description | Encounter for screening mammogram for malignant neoplasm of breast |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to Z12.31?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name Z12.31 directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does Z12.31 group to?
Z12.31 sits in MDC 23 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 951Other Factors Influencing Health Statusmedical
How is Z12.31 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to Z12.31. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Mammogram › routine (examination)
- X-ray › breast (of)
- Screening › neoplasm › breast › routine mammogram (for)
Excludes1 — never code together
The conditions below can never be reported together with Z12.31 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- inconclusive mammogram (R92.2)
Excludes1 — never code together — inherited from Z12
The conditions below can never be reported together with Z12.31 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- encounter for diagnostic examination-code to sign or symptom
Use additional code — inherited from Z12
Report an additional code alongside Z12.31 to fully describe the condition. Z12.31 is sequenced first.
- code to identify any family history of malignant neoplasm (Z80.-)
Excludes2 — not included here — inherited from Z00-Z13
The conditions below are not part of Z12.31, but a patient may have both at the same time. When documentation supports it, Z12.31 and the excluded code may both be reported.
How long has Z12.31 existed?
Z12.31 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.