ICD-10-CM Code Z86.000

Personal history of in-situ neoplasm of breast

Version 2020 Billable Code Unacceptable Principal Diagnosis POA Exempt

Valid for Submission

Z86.000 is a billable code used to specify a medical diagnosis of personal history of in-situ neoplasm of breast. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z86.000 might also be used to specify conditions or terms like history of carcinoma in situ of breast or history of ductal carcinoma in situ of breast or history of lobular carcinoma in situ. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z86.000 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:Z86.000
Short Description:Personal history of in-situ neoplasm of breast
Long Description:Personal history of in-situ 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 Z86.000:

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 D05

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 Z86.000 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:

  • History of carcinoma in situ of breast
  • History of ductal carcinoma in situ of breast
  • History of lobular carcinoma in situ

Present on Admission (POA)

Z86.000 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 Z86.000 to ICD-9

  • V13.89 - Hx diseases NEC (Approximate Flag)

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)
      • Personal history of certain other diseases (Z86)

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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