Z85.3 — Personal history of malignant neoplasm of breast
Z85.3 is a billable, specific ICD-10-CM code for personal history of malignant neoplasm of breast. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Conditions classifiable to C50.-
Risk adjustment
Z85.3 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
Z85.3 is named in 60 Medicare coverage policies — 60 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52399Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®, Wyost®, Ospomyv™,Xbryk™,Bomyntra®, Conexxence®, Stoboclo®, Osenvelt®,Bildyos®, Bilprevda®)
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
How Z85.3 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 Z85.3.
- History›personal›malignant neoplasm›breast
Related codes at this level
Codes that share Z85. If Z85.3 is not quite right, the correct code is usually one of these.
- Z85.0Personal history of malignant neoplasm of digestive organs
- Z85.1Personal history of malignant neoplasm of trachea, bronchus and lung
- Z85.2Personal history of malignant neoplasm of other respiratory and intrathoracic organs
- Z85.4Personal history of malignant neoplasm of genital organs
- Z85.5Personal history of malignant neoplasm of urinary tract
- Z85.6Personal history of leukemia
- Z85.7Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues
- Z85.8Personal history of malignant neoplasms of other organs and systems
- Z85.9Personal history of malignant neoplasm, unspecified
Questions about Z85.3
- Is Z85.3 a billable ICD-10-CM code?
- Yes. Z85.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Z85.3 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).