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Z85

Non-Billable (Header)

Personal history of malignant neoplasm

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

What This Code Means

Z85 is the ICD-10-CM diagnosis code for personal history of malignant neoplasm. Z85 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).

Header codes like Z85 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at Z85's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z85 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 2 — Not included here, may code separately

  • personal history of benign neoplasm (Z86.01-)
  • personal history of carcinoma-in-situ (Z86.00-)

Use Additional Code

  • code to identify:
  • alcohol use and dependence (F10.-)
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco dependence (Z87.891)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Code First

  • any follow-up examination after treatment of malignant neoplasm (Z08)

Child Codes

Code Hierarchy

Z85Personal history of malignant neoplasm
Z85Personal history of malignant neoplasm

More on Z85

Related condition guides

Referenced in blog posts

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