ICD-10 Coding for Personal History of Breast Cancer(Z85.3)
Complete ICD-10-CM coding and documentation guide for Personal 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 Personal History of Breast Cancer
Z85.3Primary Range
Personal history of malignant neoplasm of breast
This code is used for patients with a history of breast cancer who are no longer undergoing active treatment and have no evidence of disease.
Family history of malignant neoplasm of breast
Used to document family history of breast cancer, not personal history.
Key Information: ICD-10 code for personal history of breast cancer
Essential facts and insights about Personal History of Breast Cancer
Primary ICD-10-CM Code for personal history of breast cancer
Decision Criteria
clinical Criteria
- Patient has completed all cancer treatments and is in remission.
coding Criteria
- Code should not be used as a principal diagnosis.
documentation Criteria
- Documentation must clearly state 'history of breast cancer' with no active treatment.
Applicable To
- History of invasive breast cancer
- History of ductal carcinoma in situ (DCIS)
- History of lobular carcinoma in situ (LCIS)
Clinical Validation Requirements
- No active disease on imaging
- Completed treatment with no recurrence
- Prophylactic medication prescribed
Code-Specific Risks
- Confusing personal history with family history
- Using for active cancer cases
Coding Notes
- Ensure documentation specifies 'history of' to avoid coding as active cancer.
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 Personal 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: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with ICD-10 coding guidelines., Financial: Potential for claim denials or incorrect reimbursement.
Mitigation Strategy
Ensure documentation specifies 'history of'., Review patient records for 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
Use C50.XXX for active cases and ensure documentation reflects current treatment status.
Impact
Using Z85.3 for active cancer cases.
Mitigation Strategy
Regular training on coding guidelines and documentation review.
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 Personal History of Breast Cancer, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Personal History of Breast Cancer
Use these documentation templates to ensure complete and accurate documentation for Personal History of Breast Cancer. These templates include all required elements for proper coding and billing.
Oncology Follow-Up
Specialty: OncologyRequired Elements
- Patient history of breast cancer
- Current remission status
- Surveillance plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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