What are Family History Breast Cancer ICD-10-CM Codes?
Family history of breast cancer is a crucial risk factor when assessing a patient’s likelihood of developing breast carcinoma or other malignant neoplasm. To ensure accurate clinical documentation and billing, healthcare providers must use ICD-10-CM codes that capture genetic predispositions, personal cancer history, and encounters related to genetic susceptibility to malignant neoplasm. These diagnosis codes support screening decisions and health services planning and are present on admission (POA) reporting, especially during inpatient admission.
The following family history codes are up to date for 2025 and relevant for documenting the family history of breast, ovary, and other organs at risk.
- Z80.3 - Family history of malignant neoplasm of the breast: This is the primary ICD-10 code for patients with a family history of breast cancer, but no personal diagnosis. It denotes a familial pattern of malignant neoplasm of the breast and supports preventive health status assessments.
- Z15.02 - Genetic susceptibility to malignant neoplasm of the breast: Used for patients who have tested positive for hereditary mutations like BRCA1/BRCA2, indicating increased susceptibility to malignant neoplasm. This applies when disease genetic susceptibility is confirmed.
- Z80.41 - Family history of malignant neoplasm of the ovary: While not exclusive to breast cancer, this code reflects associated family history due to overlapping genetic risk (e.g., Lynch syndrome or BRCA-related ovarian cancers).
- Z85.3 - Personal history of malignant neoplasm of the breast: Applied when the patient has a history of breast cancer, this code helps monitor recurrence risk, spread of cancer cells, or other disease surveillance.
- Z86.010 - Personal history of bilateral prophylactic mastectomy: This documents prophylactic surgery done to reduce future risk in patients with significant family or genetic susceptibility. Often applicable when breast cancer hasn't yet developed.
- Z87.89 - Personal history of other specified conditions: Captures previous exposures or interventions, such as hormone replacement therapy, radiation, or epilepsy management, which may influence future risk of breast or other malignant neoplasm.
- Z31.5 - Encounter for genetic testing for other genetic diseases: Used when genetic counseling or evaluation occurs for conditions beyond breast or ovarian cancer. May still relate to screening in the presence of asymptomatic hemophilia, neurodevelopmental disorders, or carrier evaluations.
- Z15.01 - Genetic susceptibility to malignant neoplasm of the ovary: This applies only when a hereditary ovarian cancer risk is identified. Though often linked with breast cancer genetics, it should not be used to represent breast susceptibility.