Z86.004 — Personal history of in-situ neoplasm of other and unspecified digestive organs

BillableUnspecified

Is Z86.004 billable?

Yes, but Z86.004 is an unspecified code. Z86.004 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, Z86.004 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 Z86.004 — the more specific alternatives are listed below.

More specific alternatives

Z86.004 at a glance

Code	Z86.004
Description	Personal history of in-situ neoplasm of other and unspecified digestive organs
Billable	Yes
Code set	ICD-10-CM FY2027
Valid for encounters	October 1, 2026 – September 30, 2027

What Medicare edits apply to Z86.004?

The Medicare Code Editor screens inpatient claims before they are grouped. These edits name Z86.004 directly.

Cannot be a principal diagnosis — MCE edit 9

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 Z86.004 group to?

Z86.004 sits in MDC 23 and helps define the logic of 1 MS-DRG (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.

951Other Factors Influencing Health Statusmedical

How is Z86.004 listed in the Alphabetic Index?

These are the routes through the Alphabetic Index that lead to Z86.004. They show the wording a clinician may have documented, which often differs from the Tabular description.

History › personal › in situ neoplasm › digestive organs, specified NEC
History › personal › neoplasia › anal intraepithelial, III [AIN III]
History › personal › neoplasm › in situ › digestive organs, specified NEC

Inclusion terms

Alternative wording in documentation that is classified to Z86.004.

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

Code first — inherited from Z86

The underlying condition below must be sequenced before Z86.004. Z86.004 describes a manifestation and cannot be the principal or first-listed diagnosis.

any follow-up examination after treatment (Z09)

Excludes2 — not included here — inherited from Z86.0

The conditions below are not part of Z86.004, but a patient may have both at the same time. When documentation supports it, Z86.004 and the excluded code may both be reported.

personal history of malignant neoplasms (Z85.-)

Code also — inherited from Z77-Z99

Two codes may be needed to describe the condition fully. Whether Z86.004 is sequenced first depends on the reason for the encounter.

any follow-up examination (Z08-Z09)

How long has Z86.004 existed?

Z86.004 first appears in FY2021 (FY2020 is not available, so it may have appeared then).

Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.