ICD-10 Coding for Family History of Breast Cancer(Z80.3, Z15.02)
Complete ICD-10-CM coding and documentation guide for Family History of Breast Cancer. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Family History of Breast Cancer
Z80-Z84Primary Range
Family history of primary malignant neoplasms
This range includes codes for family history of various cancers, with Z80.3 specifically for breast cancer.
Genetic susceptibility to malignant neoplasm
This range includes codes for genetic susceptibility, such as BRCA mutations, which are relevant when documenting family history of breast cancer.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z80.3 | Family history of malignant neoplasm of breast | Use when there is a documented family history of breast cancer in first-degree relatives. |
|
| Z15.02 | Genetic susceptibility to malignant neoplasm of breast | Use when there is documented genetic testing confirming susceptibility. |
|
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 family history of breast cancer
Essential facts and insights about Family History of Breast Cancer
Primary ICD-10-CM Codes for family history of breast cancer
Decision Criteria
documentation Criteria
- Document the degree of relation and age at diagnosis for each affected relative.
Applicable To
- Family history of breast cancer
Excludes
- Personal history of breast cancer (Z85.3)
Clinical Validation Requirements
- Documented family history in first-degree relatives
- Age at diagnosis of relatives
- Lineage (maternal/paternal)
Code-Specific Risks
- Incorrectly coding personal history as family history
Coding Notes
- Ensure clear documentation of family history specifics, including relation and age at diagnosis.
Z15.02 - Genetic susceptibility to malignant neoplasm of breast
Use when there is documented genetic testing confirming susceptibility.
Applicable To
- BRCA1/BRCA2 genetic mutations
Excludes
- Family history without genetic testing (Z80.3)
Clinical Validation Requirements
- Confirmed genetic testing results
- Specific mutation details (e.g., BRCA1/BRCA2)
Coding Notes
Ensure genetic test results are documented in the patient's record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Family History of Breast Cancer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z80.3.
Impact
Clinical: Leads to inaccurate risk stratification., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Always attach genetic test results to patient records., Verify documentation before coding.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of patient records and risk assessments.
Mitigation Strategy
Ensure documentation specifies family history with details of relatives affected.
Impact
Inadequate documentation of family history details.
Mitigation Strategy
Implement structured family history questionnaires.
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 Family History of Breast Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Family History of Breast Cancer
Use these documentation templates to ensure complete and accurate documentation for Family History of Breast Cancer. These templates include all required elements for proper coding and billing.
Patient with family history of breast cancer
Specialty: OncologyRequired Elements
- Degree of relation
- Age at diagnosis
- Genetic test results if applicable
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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