Z85.819 ICD-10-CM Code: Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z85.819
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePersonal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx
A patient who previously had cancer in the lip, mouth, or throat area but the specific location is not documented.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Conditions classifiable to C00-C14
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z85.819 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z85.819 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z85.819 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z85.819 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z85.819 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z85.819 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is Z85.819 an HCC code?
No. Z85.819 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Z85.819 is the ICD-10-CM diagnosis code for personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx. A patient who previously had cancer in the lip, mouth, or throat area but the specific location is not documented. Z85.819 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).
Z85.819 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code only when the exact site of the oral/pharyngeal cancer is unknown or unspecified.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z85.819 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the exact site of the oral/pharyngeal cancer is unknown or unspecified
- •Review medical records for more specific site information before defaulting to this unspecified code