ICD-10-CM Code Z80.3

Family history of malignant neoplasm of breast

Version 2020 Billable Code Unacceptable Principal Diagnosis POA Exempt

Valid for Submission

Z80.3 is a billable code used to specify a medical diagnosis of family history of malignant neoplasm of breast. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z80.3 might also be used to specify conditions or terms like familial cancer of breast, family history of breast cancer, family history of malignant neoplasm of breast at under age 50 in second degree female relative, family history of malignant neoplasm of breast at under age 50 in second degree relative, family history of malignant neoplasm of breast diagnosed before 45 years of age, family history of malignant neoplasm of breast in first degree relative, etc The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z80.3 describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.

ICD-10:Z80.3
Short Description:Family history of malignant neoplasm of breast
Long Description:Family history of malignant neoplasm of breast

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code Z80.3:

Inclusion Terms

Inclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
  • Conditions classifiable to C50

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Z80.3 are found in the index:


Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

  • Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Familial cancer of breast
  • Family history of breast cancer
  • Family history of malignant neoplasm of breast at under age 50 in second degree female relative
  • Family history of malignant neoplasm of breast at under age 50 in second degree relative
  • Family history of malignant neoplasm of breast diagnosed before 45 years of age
  • Family history of malignant neoplasm of breast in first degree relative
  • Family history of malignant neoplasm of breast in first degree relative less than 50 years of age
  • Family history of malignant neoplasm of male breast
  • Family history of neoplasm of breast
  • FH: Breast disease

Present on Admission (POA)

Z80.3 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z80.3 to ICD-9

  • V16.3 - Family hx-breast malig

Code Classification

  • Factors influencing health status and contact with health services (Z00–Z99)
    • Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
      • Family history of primary malignant neoplasm (Z80)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Breast Cancer

Breast cancer affects one in eight women during their lives. No one knows why some women get breast cancer, but there are many risk factors. Risks that you cannot change include

  • Age - the risk rises as you get older
  • Genes - two genes, BRCA1 and BRCA2, greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested for the genes.
  • Personal factors - beginning periods before age 12 or going through menopause after age 55

Other risks include obesity, using hormone replacement therapy (also called menopausal hormone therapy), taking birth control pills, drinking alcohol, not having children or having your first child after age 35, and having dense breasts.

Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast, and discharge from a nipple. Breast self-exams and mammography can help find breast cancer early, when it is most treatable. One possible treatment is surgery. It could be a lumpectomy or a mastectomy. Other treatments include radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

Men can have breast cancer, too, but it is rare.

NIH: National Cancer Institute


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Family History

Your family history includes health information about you and your close relatives. Families have many factors in common, including their genes, environment, and lifestyle. Looking at these factors can help you figure out whether you have a higher risk for certain health problems, such as heart disease, stroke, and cancer.

Having a family member with a disease raises your risk, but it does not mean that you will definitely get it. Knowing that you are at risk gives you a chance to reduce that risk by following a healthier lifestyle and getting tested as needed.

You can get started by talking to your relatives about their health. Draw a family tree and add the health information. Having copies of medical records and death certificates is also helpful.

Centers for Disease Control and Prevention


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Breast cancer Breast cancer is a disease in which certain cells in the breast become abnormal and multiply uncontrollably to form a tumor. Although breast cancer is much more common in women, this form of cancer can also develop in men. In both women and men, the most common form of breast cancer begins in cells lining the milk ducts (ductal cancer). In women, cancer can also develop in the glands that produce milk (lobular cancer). Most men have little or no lobular tissue, so lobular cancer in men is very rare.In its early stages, breast cancer usually does not cause pain and may exhibit no noticeable symptoms. As the cancer progresses, signs and symptoms can include a lump or thickening in or near the breast; a change in the size or shape of the breast; nipple discharge, tenderness, or retraction (turning inward); and skin irritation, dimpling, or scaliness. However, these changes can occur as part of many different conditions. Having one or more of these symptoms does not mean that a person definitely has breast cancer.In some cases, cancerous tumors can invade surrounding tissue and spread to other parts of the body. If breast cancer spreads, cancerous cells most often appear in the bones, liver, lungs, or brain. Tumors that begin at one site and then spread to other areas of the body are called metastatic cancers.A small percentage of all breast cancers cluster in families. These cancers are described as hereditary and are associated with inherited gene mutations. Hereditary breast cancers tend to develop earlier in life than noninherited (sporadic) cases, and new (primary) tumors are more likely to develop in both breasts.
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