ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesZ15.01

Z15.01

Genetic susceptibility to malignant neoplasm of breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z15.01 is a billable code used to indicate a diagnosis of genetic susceptibility to malignant neoplasm of breast.

Key Diagnostic Point:

Z15.01 indicates a genetic predisposition to breast cancer, often linked to mutations in genes such as BRCA1 and BRCA2. This code is crucial for identifying patients who may benefit from enhanced screening protocols, preventive measures, and targeted aftercare. Understanding the social determinants of health, such as access to genetic counseling and socioeconomic factors, is essential for comprehensive care. Preventive strategies may include regular mammograms and MRI screenings, while aftercare can involve monitoring and managing the psychological impact of genetic risk. Coders must ensure accurate documentation of family history and genetic testing results to support the use of this code.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires detailed family history documentation
  • Involves understanding genetic testing results
  • May necessitate coordination with multiple specialties
  • Potential for varying interpretations of genetic risk

Audit Risk Factors

  • Inadequate documentation of genetic counseling
  • Failure to link preventive screenings to genetic risk
  • Misinterpretation of genetic test results
  • Lack of follow-up documentation for aftercare

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Document family history, genetic counseling referrals, and preventive screening plans.

Common Clinical Scenarios

Routine checkups for patients with a family history of breast cancer, referrals for genetic testing, and follow-up on screening results.

Billing Considerations

Consider social determinants such as access to care, insurance coverage, and patient education on genetic risks.

Public Health

Documentation Requirements

Population health data on genetic predisposition, screening rates, and outcomes.

Common Clinical Scenarios

Community outreach programs for genetic education, epidemiological studies on breast cancer incidence.

Billing Considerations

Focus on health disparities and access to genetic testing in underserved populations.

Coding Guidelines

Inclusion Criteria

Use Z15.01 When
  • Z codes are used to indicate factors influencing health status and contact with health services
  • 01 should be sequenced appropriately, often as a secondary diagnosis to indicate the need for preventive measures
  • Payer requirements may vary, so coders should verify coverage for genetic counseling and screening services

Exclusion Criteria

Do NOT use Z15.01 When
No specific exclusions found.

Related CPT Codes

81211CPT Code

BRCA1 and BRCA2 gene analysis

Clinical Scenario

Used for patients with a family history of breast cancer to assess genetic risk.

Documentation Requirements

Document the reason for testing, family history, and results.

Specialty Considerations

Primary care providers should coordinate with genetic counselors for comprehensive care.

77067CPT Code

Breast MRI

Clinical Scenario

Ordered for patients with genetic susceptibility to monitor for breast cancer.

Documentation Requirements

Indicate the need for MRI based on genetic risk factors.

Specialty Considerations

Ensure proper referral and follow-up for results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enabling better tracking of patients at risk for breast cancer and improving preventive care strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enabling better tracking of patients at risk for breast cancer and improving preventive care strategies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding genetic predispositions, enabling better tracking of patients at risk for breast cancer and improving preventive care strategies.

Resources

Clinical References

  • •
    National Comprehensive Cancer Network (NCCN) Guidelines
  • •
    American Cancer Society: Genetic Testing for Breast Cancer

Coding & Billing References

  • •
    National Comprehensive Cancer Network (NCCN) Guidelines
  • •
    American Cancer Society: Genetic Testing for Breast Cancer

Frequently Asked Questions

When should Z15.01 be used?

Z15.01 should be used when a patient has a documented genetic susceptibility to breast cancer, particularly after genetic testing has confirmed a mutation. It is essential to link this code with preventive screenings and aftercare to ensure comprehensive patient management.