Is Z85.54 a billable ICD-10-CM code?

Yes. Z85.54 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z85.54 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).

Z85.54

Z85.54 — Personal history of malignant neoplasm of ureter

Billable / specific codeICD-10-CMPOA exempt

Z85.54 is a billable, specific ICD-10-CM code for personal history of malignant neoplasm of ureter. It is valid for submission on a claim.

Risk adjustment

Z85.54 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

Z85.54 is named in 13 Medicare coverage policies — 13 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52479Oral Anticancer Drugs - Policy Article
A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
A56421Billing and Coding: CT of the Abdomen and Pelvis
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

How Z85.54 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 Z85.54.

History›personal›malignant neoplasm›ureter

Related codes at this level

Codes that share Z85.5. If Z85.54 is not quite right, the correct code is usually one of these.

Questions about Z85.54

Is Z85.54 a billable ICD-10-CM code?: Yes. Z85.54 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z85.54 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).