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).

What cannot be coded together with Q85.1?

Q85.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Q85.1 (Q85) and apply to it just the same.

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

Excludes1 inherited from the categories above Q85.1

These are not written on Q85.1, but they bind it: a note on a category applies to every code beneath it. Billing Q85.1 with anything listed here is a denial.

Written on Q85 — Phakomatoses, not elsewhere classified

ataxia telangiectasia [Louis-Bar] (G11.3)
familial dysautonomia [Riley-Day] (G90.1)

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

Code history

Q85.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

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).
What cannot be coded together with Q85.1?: Q85.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above Q85.1 (Q85) and apply to it just the same.