2025 ICD-10-CM code Z12.89
Encounter for screening for malignant neoplasm of other sites.
Medical necessity for cancer screening is based on risk factors, guidelines (e.g., USPSTF, ACS), and clinical judgment.It is crucial to document the rationale for performing the screening. For example, a patient’s personal or family history of cancer, age, or other risk factors may justify the service.
The physician's responsibility includes performing a relevant screening exam based on patient risk factors and medical guidelines, ordering appropriate diagnostic tests if indicated, counseling the patient about the results, and recommending follow-up care as necessary.
- Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
- Z12 - Encounter for screening for malignant neoplasms
In simple words: This code indicates a visit to a healthcare provider specifically for cancer screening in a location not otherwise specified (not breast, cervix, colon, prostate, or skin).
This code is used for encounters with health services for screening for a malignant neoplasm of a site other than breast, cervix, colon, prostate, or skin.It represents a reason for the encounter and should be accompanied by a procedure code if a procedure is performed.
Example 1: A patient with a family history of ovarian cancer presents for a screening pelvic ultrasound., A patient presents for a screening testicular exam., A patient presents for a screening eye exam to detect early signs of melanoma of the eye.
Documentation should include the reason for the screening (e.g., family history, symptoms), the type of screening performed, the results of the screening, and any recommendations for follow-up care.
** This code specifically excludes examinations related to pregnancy and reproduction (Z30-Z36, Z39.-). Nonspecific abnormal findings disclosed during these examinations are classified to R70-R94.This code is exempt from the Present on Admission (POA) reporting requirement.
- Payment Status: Active
- Specialties:May vary based on the specific screening performed, but common examples are: Family Medicine, Internal Medicine, Oncology, OB/GYN, Urology, Dermatology, Ophthalmology.
- Place of Service:Office, Outpatient Hospital, and other outpatient settings.