Z86.03 — Personal history of neoplasm of uncertain behavior
Z86.03 is a billable, specific ICD-10-CM code for personal history of neoplasm of uncertain behavior. It is valid for submission on a claim.
Risk adjustment
Z86.03 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
Z86.03 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
How Z86.03 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 Z86.03.
- History›personal›neoplasm›uncertain behavior
Related codes at this level
Codes that share Z86.0. If Z86.03 is not quite right, the correct code is usually one of these.
Questions about Z86.03
- Is Z86.03 a billable ICD-10-CM code?
- Yes. Z86.03 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Z86.03 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).