Abnormal Mammogram: A Step-by-Step Guide for Primary Care NPs

You ordered the screening mammogram, the patient actually completed it (a win in itself!) — but now the result comes back abnormal. What do you do next?

Let’s walk through a practical, time-saving approach that you can use in primary care.

Step 1: Ordering the Right Test

• First order: Screening mammogram

  • Diagnosis code: Z12.31 – Screening Mammogram for Breast Cancer

  • Timing: Annually starting at age 40 (earlier if high-risk — always check the most up-to-date guidelines).

• If the screening is abnormal:

  • Order a diagnostic mammogram and breast ultrasound.

  • Diagnosis code: R92.8 – Abnormal findings on diagnostic imaging of breast.

  • Specify right, left, or bilateral depending on the findings.

💡 Pro tip: I save R92.8 in my EMR because it almost always works for prior authorizations and prevents the dreaded call back asking for a different code.

Step 2: Interpreting the Results

The radiologist’s report will guide the next step:

• If normal → Follow the recommended interval (commonly 6 months or 1 year). Encourage breast self-awareness and prompt reporting of any changes.

• If suspicious/indeterminate → A biopsy may be recommended. I do not order biopsies myself — instead, I refer to a trusted breast surgeon. Whoever orders the biopsy owns the responsibility for interpretation and follow-up.

• If malignant or highly concerning → Refer directly to a breast surgeon or specialized breast center for further management (mark as urgent). 

Step 3: When to Skip the Screening Step

If the patient presents with symptoms such as pain, a palpable lump, nipple discharge, or skin changes — skip the screening mammogram. Go straight to a diagnostic mammogram + breast ultrasound with the appropriate symptom-based diagnosis code.

Practical Tips for Busy NPs

• Save your favorite codes in the EMR — it’s a time saver.

• Build a referral list: Have a go-to breast surgeon or breast center for quick and smooth referrals.

• Use the report as your roadmap: The radiologist will clearly recommend next steps.

Final Thoughts

Abnormal mammograms can feel overwhelming when you’re new in practice, but with a clear workflow, it’s very manageable. Stick to the right codes, follow report recommendations, and collaborate with specialists when needed.

👉 Want more workflows, cheat sheets, and confidence-boosting pearls? Check out my 1:1 Mentorship Program — designed to help new nurse practitioners feel supported and confident in real-world practice.