Z15.01 — Genetic susceptibility to malignant neoplasm of breast
Z15.01 is a billable, specific ICD-10-CM code for genetic susceptibility to malignant neoplasm of breast. It is valid for submission on a claim.
Risk adjustment
Z15.01 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
Z15.01 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58774Billing and Coding: Cosmetic and Reconstructive Surgery
- A59299Billing and Coding: Cosmetic and Reconstructive Surgery
How Z15.01 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 Z15.01.
- Family, familial›Li-Fraumeni(syndrome)
- Syndrome›Li-Fraumeni
- Susceptibility to disease, genetic›malignant neoplasm›breast
- Genetic›susceptibility to disease NEC›malignant neoplasm›breast
Related codes at this level
Codes that share Z15.0. If Z15.01 is not quite right, the correct code is usually one of these.
- Z15.02Genetic susceptibility to malignant neoplasm of ovary
- Z15.03Genetic susceptibility to malignant neoplasm of prostate
- Z15.04Genetic susceptibility to malignant neoplasm of endometrium
- Z15.05Genetic susceptibility to malignant neoplasm of fallopian tube(s)
- Z15.06Genetic susceptibility to malignant neoplasm of digestive system
- Z15.07Genetic susceptibility to malignant neoplasm of urinary tract
- Z15.09Genetic susceptibility to other malignant neoplasm
Questions about Z15.01
- Is Z15.01 a billable ICD-10-CM code?
- Yes. Z15.01 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Z15.01 sit in the tabular list?
- Factors influencing health status and contact with health services (Z00-Z99), in the block Genetic carrier and genetic susceptibility to disease (Z14-Z15).