Z85.819 — Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx
Is Z85.819 billable?
Yes, but Z85.819 is an unspecified code. Z85.819 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, Z85.819 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting Z85.819 — the more specific alternatives are listed below.
Z85.819 at a glance
| Code | Z85.819 |
|---|---|
| Description | Personal history of malignant neoplasm of unspecified site of lip, oral cavity, and pharynx |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to Z85.819?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name Z85.819 directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does Z85.819 group to?
Z85.819 sits in MDC Pre and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCCsurgical
- 012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CCsurgical
- 013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCCsurgical
How is Z85.819 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to Z85.819. They show the wording a clinician may have documented, which often differs from the Tabular description.
- History › personal › malignant neoplasm › oral cavity
- History › personal › malignant neoplasm › pharynx
Code first — inherited from Z85
The underlying condition below must be sequenced before Z85.819. Z85.819 describes a manifestation and cannot be the principal or first-listed diagnosis.
- any follow-up examination after treatment of malignant neoplasm (Z08)
Use additional code — inherited from Z85
Report an additional code alongside Z85.819 to fully describe the condition. Z85.819 is sequenced first.
Excludes2 — not included here — inherited from Z85
The conditions below are not part of Z85.819, but a patient may have both at the same time. When documentation supports it, Z85.819 and the excluded code may both be reported.
Code also — inherited from Z77-Z99
Two codes may be needed to describe the condition fully. Whether Z85.819 is sequenced first depends on the reason for the encounter.
- any follow-up examination (Z08-Z09)
How long has Z85.819 existed?
Z85.819 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.