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ICD-10/Z86.004

Z86.004 ICD-10-CM Code: Personal history of in-situ neoplasm of other and unspecified digestive organs

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Personal history of in-situ neoplasm of other and unspecified digestive organs is a billable ICD-10-CM diagnosis code (Z86.004).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for Z86.004 in the official ICD-10-CM tabular list.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Conditions classifiable to D01
  • Personal history of anal intraepithelial neoplasia (AIN III)

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code First

Underlying conditions that must be sequenced before this code.

  • any follow-up examination after treatment (Z09)

Code Also

Additional codes that may be required to fully describe the encounter.

  • any follow-up examination (Z08-Z09)

Change history

  • FY2020 — 2019-10-01
    Added to the code set
    Personal history of in-situ neoplasm of other and unspecified digestive organs
    FY2020 changes

Verify Before Coding

  • Billable — reportable as written.
  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of Z86.004 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • Z86.00 — Personal history of in-situ neoplasm [Hierarchy]

Referenced by Excludes2 notes

  • Z85 — Personal history of malignant neoplasm [Excludes2](via Z86.00.-): “personal history of carcinoma-in-situ (Z86.00-)”

Referenced by Use Additional Code instructions

  • Z09 — Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm [Use Additional Code](via Z86.-): “code to identify any applicable history of disease code (Z86.-, Z87.-)”

Clinical classification (CCSR)

  • FAC030 — Personal history of other disease [CCSR]

Potential MS-DRG

  • DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS [MS-DRG]: “OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)”

Index entries

  • History, personal (of), in … — History, personal (of), in situ neoplasm, digestive organs, specified NEC [Index term]
  • History, personal (of), neo… — History, personal (of), neoplasia, anal intraepithelial, III [AIN III] [Index term]
  • History, personal (of), neo… — History, personal (of), neoplasm, in situ, digestive organs, specified NEC [Index term]

Nearest codes (40)

  • Z86 — Personal history of certain other diseases [Sibling]
  • Z86.0 — Personal history of in-situ and benign neoplasms and neoplasms of uncertain behavior [Sibling]
  • Z86.00 — Personal history of in-situ neoplasm [Sibling]
  • Z86.000 — Personal history of in-situ neoplasm of breast [Sibling]
  • Z86.001 — Personal history of in-situ neoplasm of cervix uteri [Sibling]
  • Z86.002 — Personal history of in-situ neoplasm of other and unspecified genital organs [Sibling]
  • Z86.003 — Personal history of in-situ neoplasm of oral cavity, esophagus and stomach [Sibling]
  • Z86.005 — Personal history of in-situ neoplasm of middle ear and respiratory system [Sibling]
  • and 32 more

Change history

  • FY2020 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):FAC030 — Personal history of other disease (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 1 MS-DRG: DRG 951 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name Z86.004 or its code family.

1 Excludes2 notes: Z85 (via Z86.00.-).

1 Use Additional Code instructions: Z09 (via Z86.-).

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Z86.004 in its code family, with their registry titles.

  • Z86.00 — Personal history of in-situ neoplasm
  • Z86.000 — Personal history of in-situ neoplasm of breast
  • Z86.001 — Personal history of in-situ neoplasm of cervix uteri
  • Z86.002 — Personal history of in-situ neoplasm of other and unspecified genital organs
  • Z86.003 — Personal history of in-situ neoplasm of oral cavity, esophagus and stomach
  • Z86.005 — Personal history of in-situ neoplasm of middle ear and respiratory system
  • Z86.006 — Personal history of melanoma in-situ
  • Z86.007 — Personal history of in-situ neoplasm of skin
  • Z86.008 — Personal history of in-situ neoplasm of other site
  • Z86.00A — Personal history of in-situ neoplasm of the fallopian tube(s)

View all codes in the Z86 family

Indexed Clinical Terms (3)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • History, personal (of), in situ neoplasm, digestive organs, specified NEC
  • History, personal (of), neoplasia, anal intraepithelial, III [AIN III]
  • History, personal (of), neoplasm, in situ, digestive organs, specified NEC