2025 ICD-10-CM code Z86.00
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Chapter 21: Factors influencing health status and contact with health services Feed
Personal history of in-situ neoplasm.
Modifiers might be applicable depending on the services provided and the circumstances of the visit.Refer to the official modifier guidelines for details.
The medical necessity for the encounter will depend on the reason for the visit, for example, follow-up care for a prior malignancy, addressing potential long-term complications, or implementing preventative measures.The documentation should clearly demonstrate the need for the visit based on clinical guidelines and risk factors.
The clinical responsibility would involve assessing the patient's history of in-situ neoplasm, reviewing any relevant imaging or pathology reports, conducting a physical examination relevant to the past neoplasm's location, and providing counseling regarding ongoing monitoring or management of potential risks associated with the prior neoplasm.The physician may order further investigations based on the clinical picture.
- Chapter 21: Factors influencing health status and contact with health services
- Z86.00 is a sub-category under Z86, which falls under the broader category Z77-Z99 (Persons with potential health hazards related to family and personal history and certain conditions influencing health status).
In simple words: This code means the patient has had a non-invasive type of cancer in the past that hasn't spread.The doctor is seeing the patient for a check-up or to address issues related to that past cancer, not for treatment of the cancer itself.
This code signifies a documented history of an in-situ neoplasm (a non-invasive cancerous growth that hasn't spread to other tissues).It's used when a patient presents for care related to this past condition, such as follow-up examinations or management of potential risks, but not for treatment of the in-situ neoplasm itself. A procedure code should accompany this code if a procedure is performed during the encounter.
Example 1: A 55-year-old female patient presents for a routine check-up five years after successful treatment for in-situ ductal carcinoma of the breast. The physician reviews her medical history, performs a breast examination, and orders a mammogram., A 60-year-old male patient is seen for a consultation regarding potential long-term effects of a previously treated in-situ squamous cell carcinoma of the skin.The consultation focuses on preventative measures and early detection strategies., A 40-year-old female patient presents for routine gynecological care. She has a history of in-situ cervical cancer treated 10 years earlier. The physician orders a Pap smear and discusses preventative screenings.
Complete medical history detailing the prior in-situ neoplasm, including the location, type, date of diagnosis, treatment received, and pathology reports.Documentation of the current encounter should detail the reason for the visit, the physician's findings from the physical exam, any ordered tests, and the plan for future management.
** Always confirm the most up-to-date coding guidelines before using this code to ensure accuracy and proper reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable to this ICD-10 code.
- Specialties:Oncology, General Surgery, Gynecology, Dermatology, Urology
- Place of Service:Office, Outpatient Hospital, Clinic