ICD-10 Coding for History of Breast Carcinoma(Z85.3)
Complete ICD-10-CM coding and documentation guide for History of Breast Carcinoma. 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 Carcinoma
Z85.3Primary Range
Personal history of malignant neoplasm of breast
Used for patients with a history of breast cancer who are no longer undergoing active treatment.
Encounter for follow-up examination after completed treatment for malignant neoplasm
Used for follow-up visits after cancer treatment to monitor for recurrence.
Long-term (current) use of agents affecting estrogen receptors and estrogen levels
Used when a patient is on long-term medication like tamoxifen for prophylaxis.
Key Information: ICD-10 code for history of breast cancer
Essential facts and insights about History of Breast Carcinoma
Primary ICD-10-CM Code for history of breast carcinoma
Decision Criteria
clinical Criteria
- Patient has completed all cancer treatment and is in remission.
documentation Criteria
- Records indicate no active treatment and surveillance only.
Applicable To
- History of breast cancer
Excludes
- Current breast cancer (C50.-)
Clinical Validation Requirements
- No evidence of active disease on imaging
- Completed treatment documented
- No current symptoms indicative of active cancer
Code-Specific Risks
- Incorrectly coding active treatment as history
- Lack of documentation for remission
Coding Notes
- Ensure documentation clearly states 'history of' and 'no evidence of disease'.
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 Carcinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z85.3.
Impact
Clinical: Misrepresentation of patient status., Regulatory: Potential audit issues., Financial: Claim denials due to insufficient documentation.
Mitigation Strategy
Always document treatment history and current status.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use C50.xxx if the patient is receiving active treatment.
Impact
Using Z85.3 for patients still receiving treatment.
Mitigation Strategy
Verify treatment status before coding.
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 Carcinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Breast Carcinoma
Use these documentation templates to ensure complete and accurate documentation for History of Breast Carcinoma. These templates include all required elements for proper coding and billing.
Post-treatment follow-up
Specialty: OncologyRequired Elements
- Patient history
- Treatment completion date
- Current disease status
- Surveillance plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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