ICD-10 Coding for BRCA Mutation(Z15.01, Z15.02)
Complete ICD-10-CM coding and documentation guide for BRCA Mutation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to BRCA Mutation
Z15.01-Z15.02Primary Range
Genetic susceptibility to malignant neoplasm of breast and ovary
These codes are used to identify patients with a confirmed BRCA1 or BRCA2 mutation, indicating a genetic susceptibility to breast and ovarian cancer.
Family history of primary malignant neoplasm
These codes are used to document family history of cancer, which may influence genetic testing and surveillance strategies.
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 or BRCA2 mutation indicating increased risk for breast cancer. |
|
| Z15.02 | Genetic susceptibility to malignant neoplasm of ovary | Use when a patient has a confirmed BRCA1 or BRCA2 mutation indicating increased risk for ovarian cancer. |
|
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 mutation
Essential facts and insights about BRCA Mutation
Primary ICD-10-CM Codes for brca
Decision Criteria
clinical Criteria
- Confirmed BRCA1/2 mutation via genetic testing
documentation Criteria
- Provider must document genetic susceptibility
Applicable To
- BRCA1 mutation
- BRCA2 mutation
Excludes
- Family history of breast cancer (Z80.3)
Clinical Validation Requirements
- Genetic test report confirming BRCA1/2 mutation
- Provider documentation confirming genetic susceptibility
Code-Specific Risks
- Incorrectly coding family history as personal genetic susceptibility.
Coding Notes
- Ensure genetic test results are documented and linked to the code.
Z15.02 - Genetic susceptibility to malignant neoplasm of ovary
Use when a patient has a confirmed BRCA1 or BRCA2 mutation indicating increased risk for ovarian cancer.
Applicable To
- BRCA1 mutation
- BRCA2 mutation
Excludes
- Family history of ovarian cancer (Z80.41)
Clinical Validation Requirements
- Genetic test report confirming BRCA1/2 mutation
- Provider documentation confirming genetic susceptibility
Coding Notes
Ensure genetic test results are documented and linked to the code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening for other disorder
Z13.89Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting BRCA Mutation 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 surveillance or treatment., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to incorrect coding.
Mitigation Strategy
Verify genetic test results before coding., Ensure provider documentation specifies personal vs. family history.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Using outdated codes can result in non-compliance with coding standards., Data Quality: Impacts the accuracy of patient records and data analytics.
Mitigation Strategy
Always use the most current ICD-10 codes, such as Z15.01 for BRCA1 mutation.
Impact
Using family history codes instead of genetic susceptibility codes.
Mitigation Strategy
Ensure genetic test results are reviewed and documented by the provider.
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 Mutation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for BRCA Mutation
Use these documentation templates to ensure complete and accurate documentation for BRCA Mutation. These templates include all required elements for proper coding and billing.
Prophylactic Surgery in BRCA+ Patient
Specialty: OncologyRequired Elements
- Genetic test confirmation
- Provider documentation of mutation
- Surgical plan and rationale
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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