ICD-10 Coding for History of Breast Cancer(Z85.3, Z80.3)
Complete ICD-10-CM coding and documentation guide for 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 History of Breast Cancer
Z85.3Primary Range
Personal history of malignant neoplasm of breast
Used when the patient has a history of breast cancer but is currently free of the disease.
Family history of malignant neoplasm of breast
Used to indicate a family history of breast cancer, which may influence screening and risk assessment.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z85.3 | Personal history of malignant neoplasm of breast | Use when the patient has completed treatment and is in remission with no evidence of active disease. |
|
| Z80.3 | Family history of malignant neoplasm of breast | Use when documenting a family history of breast cancer to assess risk and screening needs. |
|
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 history of breast cancer
Essential facts and insights about History of Breast Cancer
Primary ICD-10-CM Codes for history of breast cancer
Decision Criteria
clinical Criteria
- Patient has completed all curative treatments and is in remission.
documentation Criteria
- Medical record states 'no evidence of disease'.
Applicable To
- History of breast cancer in remission
Excludes
- Current breast cancer (C50.-)
Clinical Validation Requirements
- Documentation of 'no evidence of disease' (NED)
- Completion of curative treatment
- Surveillance imaging showing no recurrence
Code-Specific Risks
- Incorrectly using this code for patients still undergoing active treatment.
Coding Notes
- Ensure documentation clearly states the cancer is in remission and not under active treatment.
Z80.3 - Family history of malignant neoplasm of breast
Use when documenting a family history of breast cancer to assess risk and screening needs.
Applicable To
- Family history of breast cancer
Clinical Validation Requirements
- Documentation of family history, including first-degree relatives with breast cancer.
Coding Notes
Ensure family history is clearly documented in the patient's medical record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Breast Cancer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z85.3.
Impact
Clinical: Potential mismanagement of patient care., Regulatory: Non-compliance with documentation standards., Financial: Risk of claim denials due to incorrect coding.
Mitigation Strategy
Ensure clear documentation of cancer status., Use specific phrases like 'no evidence of disease'.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use active cancer codes (C50.-) if the patient is still receiving treatment.
Impact
Using Z85.3 for patients still undergoing active treatment.
Mitigation Strategy
Regularly review treatment status and update codes accordingly.
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 History of Breast Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Breast Cancer
Use these documentation templates to ensure complete and accurate documentation for History of Breast Cancer. These templates include all required elements for proper coding and billing.
Surveillance Visit Post-Breast Cancer Treatment
Specialty: OncologyRequired Elements
- Patient's current status
- Past treatment details
- Surveillance plan
- Absence of symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for History of Breast Cancer? Ask your questions below.