ICD-10 Coding for History of Colorectal Cancer(Z85.038, Z86.010)
Complete ICD-10-CM coding and documentation guide for History of Colorectal 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 Colorectal Cancer
Z85.03-Z85.038Primary Range
Personal history of malignant neoplasm of digestive organs
This range includes codes for personal history of malignant neoplasm of the colon, which is essential for documenting patients with a history of colorectal cancer.
Personal history of colonic polyps
This code is relevant for patients with a history of colonic polyps, which may be associated with colorectal 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 |
|---|---|---|---|
| Z85.038 | Personal history of malignant neoplasm of colon | Use when the patient has completed treatment for colon cancer and there is no evidence of active disease. |
|
| Z86.010 | Personal history of colonic polyps | Use for patients with a documented history of adenomatous colonic polyps. |
|
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 colorectal cancer
Essential facts and insights about History of Colorectal Cancer
Primary ICD-10-CM Codes for history of colorectal cancer
Decision Criteria
clinical Criteria
- Patient has completed all cancer-directed therapy and is in remission.
documentation Criteria
- Surveillance plan and no evidence of disease must be documented.
Applicable To
- History of colon cancer
- History of rectal cancer
Clinical Validation Requirements
- No evidence of active disease
- Completion of cancer-directed therapy
- Surveillance colonoscopy results
Code-Specific Risks
- Incorrectly coding active cancer as history
- Missing documentation of treatment completion
Coding Notes
- Ensure documentation clearly states the cancer is in remission and no active treatment is ongoing.
Z86.010 - Personal history of colonic polyps
Use for patients with a documented history of adenomatous colonic polyps.
Applicable To
- History of adenomatous polyps
Excludes
- Current colonic polyps (K63.5)
Clinical Validation Requirements
- Pathology report confirming adenomatous polyps
Coding Notes
Ensure pathology reports are referenced in documentation.
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 Colorectal Cancer to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z85.038.
Impact
Clinical: Misrepresentation of patient status, Regulatory: Potential audit issues, Financial: Incorrect billing and potential claim denials
Mitigation Strategy
Regularly review patient treatment status, Update records promptly after treatment completion
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Verify if the cancer is truly in remission and all treatments are completed.
Impact
Risk of coding history of cancer when the disease is still active.
Mitigation Strategy
Implement regular training on cancer coding guidelines.
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 Colorectal Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Colorectal Cancer
Use these documentation templates to ensure complete and accurate documentation for History of Colorectal Cancer. These templates include all required elements for proper coding and billing.
Post-treatment follow-up for colorectal cancer
Specialty: OncologyRequired Elements
- Patient history
- Treatment completion date
- Surveillance plan
- Current status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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