Is Q85.1 a billable ICD-10-CM code?

Yes. Q85.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Q85.1 sit in the tabular list?

Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Other congenital malformations (Q80-Q89).

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.

Inclusion 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.

Medicare coverage

Q85.1 is named in 6 Medicare coverage policies — 6 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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)

How Q85.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Q85.1.

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

Related codes at this level

Codes that share Q85. If Q85.1 is not quite right, the correct code is usually one of these.

Questions about Q85.1

Is Q85.1 a billable ICD-10-CM code?: Yes. Q85.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Q85.1 sit in the tabular list?: Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Other congenital malformations (Q80-Q89).