Is Z79.81 a billable ICD-10-CM code?

No. Z79.81 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does Z79.81 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).

What cannot be coded together with Z79.81?

Z79.81 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Z79.81

Z79.81 — Long term (current) use of agents affecting estrogen receptors and estrogen levels

Non-billable headerICD-10-CM

Z79.81 is a non-billable header ICD-10-CM code for long term (current) use of agents affecting estrogen receptors and estrogen levels. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

hormone replacement therapy (Z79.890)

Code first

The underlying condition must be sequenced before this code.

, if applicable:
malignant neoplasm of breast (C50.-)
malignant neoplasm of prostate (C61)

Use additional code

Add a secondary code to capture the detail described below.

code, if applicable, to identify:
estrogen receptor positive status (Z17.0)
family history of breast cancer (Z80.3)
genetic susceptibility to malignant neoplasm (cancer) (Z15.0-)
personal history of breast cancer (Z85.3)
personal history of prostate cancer (Z85.46)
postmenopausal status (Z78.0)

Risk adjustment

Z79.81 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.

Code to one of these instead Z79.81

3 child codes. Green means billable.

Related codes at this level

Codes that share Z79.8. If Z79.81 is not quite right, the correct code is usually one of these.

Questions about Z79.81

Is Z79.81 a billable ICD-10-CM code?: No. Z79.81 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does Z79.81 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
What cannot be coded together with Z79.81?: Z79.81 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.