ICD-10 Coding for BRCA Positive(Z15.01, Z15.02)
Complete ICD-10-CM coding and documentation guide for BRCA Positive. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to BRCA Positive
Z15-Z15.09Primary Range
Genetic susceptibility to disease
This range includes codes for genetic susceptibility to breast and ovarian cancers, specifically for BRCA mutations.
Family history of primary malignant neoplasm
This range is relevant for documenting family history of breast and ovarian cancers.
Personal history of malignant neoplasm
This range is used for documenting personal history of breast and ovarian cancers.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z15.01 | Genetic susceptibility to malignant neoplasm of breast | Use when a patient has a confirmed BRCA1/2 pathogenic variant without active cancer. |
|
| Z15.02 | Genetic susceptibility to malignant neoplasm of ovary | Use when a patient has a confirmed BRCA1/2 pathogenic variant with ovarian cancer risk. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for BRCA positive
Essential facts and insights about BRCA Positive
Primary ICD-10-CM Codes for brca positive
Decision Criteria
clinical Criteria
- Confirmed BRCA1/2 pathogenic variant via germline testing
documentation Criteria
- Detailed genetic test report with specific mutation
Applicable To
- BRCA1 pathogenic variant
- BRCA2 pathogenic variant
Excludes
- Somatic mutations in breast cancer
Clinical Validation Requirements
- Germline test report specifying BRCA1/2 pathogenic variant
- NCCN testing criteria met
Code-Specific Risks
- Using for somatic mutations instead of germline
- Coding VUS as pathogenic
Coding Notes
- Ensure genetic testing confirms pathogenic variant before using this code.
Z15.02 - Genetic susceptibility to malignant neoplasm of ovary
Use when a patient has a confirmed BRCA1/2 pathogenic variant with ovarian cancer risk.
Applicable To
- BRCA1 pathogenic variant
- BRCA2 pathogenic variant
Excludes
- Somatic mutations in ovarian cancer
Clinical Validation Requirements
- Germline test report specifying BRCA1/2 pathogenic variant
- NCCN testing criteria met
Coding Notes
Ensure genetic testing confirms pathogenic variant before using this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Family history of malignant neoplasm of breast
Z80.3Personal history of malignant neoplasm of breast
Z85.3Family history of malignant neoplasm of ovary
Z80.4Personal history of malignant neoplasm of ovary
Z85.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Estrogen receptor positive status
Z17.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting BRCA Positive to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z15.01.
Impact
Clinical: May lead to inappropriate management decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Use specific mutation details in documentation, Ensure genetic testing confirmation is included
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use Z17.1 for somatic mutations identified in tumor testing.
Impact
Reimbursement: May result in claim rejections., Compliance: Violates coding standards for genetic testing., Data Quality: Misrepresents genetic risk in patient records.
Mitigation Strategy
Use Z84.89 for VUS findings.
Impact
Incomplete documentation of genetic testing results and counseling.
Mitigation Strategy
Ensure all genetic test reports are complete and counseling sessions are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for BRCA Positive, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for BRCA Positive
Use these documentation templates to ensure complete and accurate documentation for BRCA Positive. These templates include all required elements for proper coding and billing.
Genetic Counseling for BRCA Mutation
Specialty: GeneticsRequired Elements
- Patient identification
- Specific BRCA mutation details
- Counseling session notes
- Management plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for BRCA Positive? Ask your questions below.