Q85.1
Q85.1: Tuberous sclerosis
Billable / specific codeICD-10-CMPOA exempt
Q85.1 is a billable, specific ICD-10-CM code for tuberous sclerosis. It is valid for submission on a claim.
Check Q85.1 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Bourneville's disease
- Epiloia
Risk adjustment
Q85.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
Q85.1 is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56621Billing and Coding: Swallowing Studies for Dysphagia
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
- A57071Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Alphabetic index entries that lead here
- Bourneville's disease
- Epiloia
- Neurospongioblastosis diffusa
- Pringle's disease(tuberous sclerosis)
- Tuberous sclerosis(brain)
- Disease, diseased›Bourneville(-Brissaud) (tuberous sclerosis)
- Disease, diseased›Pringle's(tuberous sclerosis)
- Nevus›multiplex
- Phakomatosis›Bourneville's
- Sclerosis, sclerotic›tuberous(brain)
- Syndrome›Bourneville(-Pringle)
- Sclerosis, sclerotic›brain›tuberous
Code history
Unchanged in every release from FY2024 to FY2027.