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ICD-10 Guide
ICD-10 CodesChapter 21: Factors influencing health statusZ86

Z86

Non-billable

Personal history of certain other diseases

Chapter 21:Factors influencing health status

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 Z86 is a used to indicate a diagnosis of personal history of certain other diseases.

Key Diagnostic Point:

The ICD-10 Level 1 Category code Z86 pertains to the personal history of certain other diseases. This category is designed to capture a patient's past medical history of specific conditions that may not be currently active but could influence future healthcare decisions and risk assessments. Conditions covered under this category include, but are not limited to, previous diagnoses of diseases such as tuberculosis, certain cancers, and other significant health issues that have been resolved or treated. Documenting these conditions is crucial for providing comprehensive patient care and ensuring that healthcare providers are aware of the patient's medical background, which can affect treatment choices and preventive measures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions covered
  • Potential for overlapping diagnoses
  • Need for accurate patient history documentation

Audit Risk Factors

  • Inaccurate coding of past conditions
  • Failure to document history accurately
  • Misinterpretation of patient history

Specialty Focus

Medical Specialties

Family Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Internal Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical and administrative impact of the Z86 code category is significant, as it helps healthcare providers identify patients at risk for certain conditions based on their medical history. This can lead to improved quality measures and better population health management, as providers can implement preventive strategies tailored to individual patient needs. Furthermore, as healthcare trends shift towards value-based care, accurate coding of personal history becomes increasingly important for tracking outcomes and ensuring appropriate resource allocation.

ICD-9 vs ICD-10

The clinical and administrative impact of the Z86 code category is significant, as it helps healthcare providers identify patients at risk for certain conditions based on their medical history. This can lead to improved quality measures and better population health management, as providers can implement preventive strategies tailored to individual patient needs. Furthermore, as healthcare trends shift towards value-based care, accurate coding of personal history becomes increasingly important for tracking outcomes and ensuring appropriate resource allocation.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is essential to check specific guidelines to ensure compliance. Additionally, common billing practices include using Z86 codes in conjunction with other active diagnosis codes to provide a complete picture of the patient's health status.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for Z86

Coding & Billing References

  • •
    Official ICD-10 Guidelines for Z86

Frequently Asked Questions

What conditions are included in Z86?

Z86 includes a variety of conditions such as personal history of certain cancers, tuberculosis, and other significant diseases that have been resolved. It is important to refer to specific subcategories for detailed conditions.

When should I use Z86 codes?

Z86 codes should be used when documenting a patient's personal history of certain diseases that are no longer active but may impact current health status or treatment decisions.

What documentation is required for Z86?

Documentation for Z86 should include a clear record of the patient's past medical history, including dates of diagnosis, treatment received, and current status of the condition.