Q85.81

Q85.81: PTEN hamartoma tumor syndrome

Billable / specific codeICD-10-CMPOA exempt

Q85.81 is a billable, specific ICD-10-CM code for pten hamartoma tumor syndrome. It is valid for submission on a claim.

Check Q85.81 with the rest of the claim: free scrubber

Code also

Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.

, if applicable, genetic susceptibility to malignant neoplasm (Z15.0-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

PHTS
PTEN related Cowden syndrome

Excludes1 inherited from the categories above Q85.81

A category’s note binds every code beneath it.

Written on Q85.8: Other phakomatoses, not elsewhere classified

Meckel-Gruber syndrome (Q61.9)

Written on Q85: Phakomatoses, not elsewhere classified

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

Risk adjustment

Q85.81 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

Q85.81 is named in 12 Medicare coverage policies: 12 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56394Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
A56461Billing and Coding: Endoscopy by Capsule
A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)