Is Z86.16 a billable ICD-10-CM code?

Yes. Z86.16 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does Z86.16 sit in the tabular list?

Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).

What cannot be coded together with Z86.16?

Z86.16 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

Z86.16

Z86.16 — Personal history of COVID-19

Billable / specific codeICD-10-CMPOA exempt

Z86.16 is a billable, specific ICD-10-CM code for personal history of covid-19. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

post COVID-19 condition (U09.9)

Risk adjustment

Z86.16 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

Z86.16 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57224Billing and Coding: Respiratory Care

How Z86.16 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to Z86.16.

COVID-19›history of(personal)
History›personal›coronavirus 2019(disease) (novel)
History›personal›COVID-19
History›personal›SARS-CoV-2 infection
History›personal›infection NEC›coronavirus 2019(disease) (novel)
History›personal›infection NEC›COVID-19
History›personal›infection NEC›SARS-CoV-2
History›personal›disease or disorder›infectious›coronavirus 2019(disease) (novel)
History›personal›disease or disorder›infectious›COVID-19
History›personal›disease or disorder›infectious›SARS-CoV-2

Related codes at this level

Codes that share Z86.1. If Z86.16 is not quite right, the correct code is usually one of these.

Questions about Z86.16

Is Z86.16 a billable ICD-10-CM code?: Yes. Z86.16 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does Z86.16 sit in the tabular list?: Factors influencing health status and contact with health services (Z00-Z99), in the block Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99).
What cannot be coded together with Z86.16?: Z86.16 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.