Z85.9 ICD-10-CM Code: Personal history of malignant neoplasm, unspecified
HCC Buddy Code Card
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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)
Z85.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePersonal history of malignant neoplasm, unspecified
A patient with a history of cancer, but the specific type or location of the original cancer is not documented or specified.
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 C7A.00, C80.1
Excludes 2
Official- personal history of benign neoplasm (Z86.01-)
- personal history of carcinoma-in-situ (Z86.00-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z85.9 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for Z85.9 in this effective period.
Code First
Official- any follow-up examination after treatment of malignant neoplasm (Z08)
Use Additional
Official- 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)
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z85.9 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 Z85.9 an HCC code?
No. Z85.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Z85.9 is the ICD-10-CM diagnosis code for personal history of malignant neoplasm, unspecified. A patient with a history of cancer, but the specific type or location of the original cancer is not documented or specified. Z85.9 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).
Z85.9 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.
Avoid using this code when more specific information is available; query the provider for cancer site details.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z85.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Avoid using this code when more specific information is available; query the provider for cancer site details
- •This code should only be used when the cancer site cannot be determined from available documentation