Is ICD-10-CM code Z85 billable?

No, Z85 (Personal history of malignant neoplasm) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code Z85 belong to?

Z85 belongs to Chapter 21 of the ICD-10-CM tabular list: Z00–Z99 (Factors Influencing Health Status and Contact with Health Services).

Z85Not billable, use a more specific code below

Personal history of malignant neoplasm

In Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99), chapter 21: Factors Influencing Health Status and Contact with Health Services

60 billable codes under Z85: none are a CC or MCC; none map to an HCC.

Instructional notes

Excludes2: not included here, code separately if applicable

personal history of benign neoplasm (Z86.01-)
personal history of carcinoma-in-situ (Z86.00-)

Code first: code the underlying condition first, then this code

any follow-up examination after treatment of malignant neoplasm (Z08)

Use additional code: add a second code for this, listed after this one

code to identify:
alcohol use and dependence (F10.-)
exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Also applies, from Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)

These notes sit on Z77-Z99 and apply to every code under it, including Z85.

Code also: add a code for this too, order depends on the encounter

any follow-up examination (Z08-Z09)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Section I.C.2.d Primary malignancy previously excised (page 34), covers Z85
When a primary cancer was excised or eradicated with no further treatment or evidence of disease at that site, use a Z85 code. Code any extension or metastasis as a secondary neoplasm, which may be sequenced first.
Section I.C.2.m Current malignancy versus personal history of malignancy (page 38), covers Z85
Keep coding the primary malignancy while treatment to that site continues. Use Z85 once it is excised or eradicated with no further treatment or evidence of disease. Z85.0 to Z85.85 are for former primary sites only.

All codes under Z85

Z85 can't be used on a claim. Pick a billable code below; grey headings group them.

Z85 MS-DRGs

As the principal diagnosis, the billable codes under Z85 group to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

Other codes that refer to Z85

Notes on these codes point to Z85.

QA1 Code Also: personal history of malignant neoplasm (Z85.-)
Z08 Use Additional Code: code to identify the personal history of malignant neoplasm (Z85.-)
Z15.0 Use Additional Code: code, if applicable, for any personal history of malignant neoplasm (Z85.-)
Z86.0 Excludes2: personal history of malignant neoplasms (Z85.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Cancer

Cancer is not just one disease but many diseases. Cancer begins in your cells, which are the building blocks of your body. Usually, your body forms new cells as needed, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.