Is Z86.0101 a billable ICD-10-CM code?

Yes. Z86.0101 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z86.0101 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).

Z86.0101

Z86.0101 — Personal history of adenomatous and serrated colon polyps

Billable / specific codeICD-10-CMPOA exempt

Z86.0101 is a billable, specific ICD-10-CM code for personal history of adenomatous and serrated colon polyps. It is valid for submission on a claim.

Inclusion terms

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

Personal history of tubular adenoma polyps
Personal history of sessile adenomatous colon polyp
Personal history of sessile serrated colon polyp
Personal history of tubulovillous adenoma polyps
Personal history of villous adenoma polyps
Personal history of traditional serrated adenoma polyps

Risk adjustment

Z86.0101 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

Z86.0101 is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A55937Billing and Coding: Diagnostic Colonoscopy
A56394Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
A56456Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
A56612Billing and Coding: CT of the Head

How Z86.0101 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 Z86.0101.

History›personal›neoplasm›benign›colon polyp›adenomatous(sessile)
History›personal›neoplasm›benign›colon polyp›serrated(sessile)
History›personal›neoplasm›benign›colon polyp›traditional serrated adenoma
History›personal›neoplasm›benign›colon polyp›tubular adenoma
History›personal›neoplasm›benign›colon polyp›tubulovillous adenoma
History›personal›neoplasm›benign›colon polyp›villous adenoma

Related codes at this level

Codes that share Z86.010. If Z86.0101 is not quite right, the correct code is usually one of these.

Questions about Z86.0101

Is Z86.0101 a billable ICD-10-CM code?: Yes. Z86.0101 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z86.0101 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).