Please research online as needed. This is a correct medical coding question and requires agentic research and internet research. There are codes for colon neoplasm such as C18.6 or C18.7. There is also a set of cancer codes beginning with "Z" such as perosnal history of malignant neoplasm of large intesting, Z85.038. Here is the question. Does use of a Z code require that the cancer is no longer present? I would think not. If I have a persona lhistory of diabetes, I had diabetes yesterday and still today. I would think Z85.038 by its text would cover both a history of treated and cured cancer ("a personal history...") as well as being inclusive of someone who might have residual, metastatic, or lingering cancer today. Is there an official correct coding position and can it be documented objectivey.
Examples.
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
Z85.038 Personal history of other malignant neoplasm of large intestine
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I'll research this carefully. This is a specific medical coding question with an objective answer in the ICD-10-CM Official Guidelines for Coding and Reporting.I'm getting clear signals that the official guidelines treat "personal history" differently than the user's intuition. Let me get the authoritative source — the ICD-10-CM Official Guidelines for Coding and Reporting, specifically Section I.C.21 on history (of) codes.Excellent — I have the definitive answer directly from the ICD-10-CM Official Guidelines for Coding and Reporting. Let me grab one more authoritative source to confirm the exact wording and cite the CDC/CMS document.I have a definitive, citable answer. Here it is:
Short answer
Your intuition is wrong on this one, and there's an objective, citable rule. In ICD-10-CM, "personal history of malignant neoplasm" (Z85.-) explicitly requires that the cancer no longer exists and is not being treated. It is not a parallel to "personal history of diabetes" — in coding, "history of" is a term of art, not the everyday English meaning.
The official rule
The ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.21.c.4 ("History (of)"), states:
"Personal history codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring."
That's the controlling sentence. It is published annually by CDC/NCHS and CMS and is incorporated by reference into HIPAA code-set rules, so it has regulatory weight, not just guideline weight. The American Hospital Association's Coding Clinic and the AHA's published FAQs cite this exact language when adjudicating disputes.
So for your colon example:
- Patient currently has malignant neoplasm of the sigmoid colon, on chemo, or with known residual/metastatic disease → C18.7 (or the appropriate active C-code, plus secondary site codes like C78.- for mets). Z85.038 is wrong.
- Patient had sigmoid colon cancer, was resected, has completed treatment, NED (no evidence of disease), now under surveillance → Z85.038.
- Patient had sigmoid colon cancer, primary tumor resected, but has known liver metastases still present and/or is on treatment → still active cancer; code the metastatic site (e.g., C78.7) and, per Coding Clinic, the primary may still be coded as active if treatment is directed at the disease. Z85.038 is still wrong.
Why your diabetes analogy fails
In plain English, "personal history of X" can mean "X has happened to me, including right now." In ICD-10-CM, the phrase has been given a narrower technical definition by the guideline above. The same logic is why there is no "personal history of diabetes" Z code — diabetes is chronic and ongoing, so you code the active disease (E11.-, etc.).
The Z85 family exists precisely to flag a resolved malignancy that still matters clinically (surveillance, screening intervals, risk stratification, family counseling).
The companion concept is the distinction between history codes and status codes:
- History codes (Z85, Z86, Z87, etc.) — condition no longer present, but clinically relevant.
- Status codes (Z89–Z99) — a current, ongoing state (e.g., Z90.49 acquired absence of part of digestive tract after colectomy, Z93.- ostomy status).
- These are current and can coexist with either an active C-code or a Z85 history code.
The "still has cancer" trap and the AHA position
Coders frequently see notes that say "history of colon cancer" when the patient in fact still has measurable disease, is on maintenance chemo, or has known mets.
Coding Clinic has repeatedly said: do not take the provider's word "history" at face value [for using a Z code]; review the record, and if the cancer is still being treated or is still present anywhere (including metastases), code it as active. Query the provider if unclear.
The COVID-19 FAQ from AHA quotes the same I.C.21.c.4 language to make exactly this point in a different disease context — a personal history code is not appropriate when the patient is "clearly receiving treatment" for the condition or its residual effects.
The plain-English summary from a coding education source captures it well: "[In ICD10] History codes apply only after the condition has been fully treated and no longer exists." And the corresponding error: "Assigning Z85 (personal history of malignant neoplasm) while the patient is still undergoing active cancer treatment is incorrect."
How to document this objectively
If you ever need to defend the position in an audit, chart review, or payer dispute, the citation chain is:
- ICD-10-CM Official Guidelines for Coding and Reporting, current fiscal year, Section I.C.21.c.4, "History (of)" — the binding definition. Available as a free PDF on the CDC NCHS site (cdc.gov/nchs/icd/icd-10-cm) and on cms.gov.
- AHA Coding Clinic for ICD-10-CM/PCS — quarterly publication with case-level adjudications; multiple issues address active-vs-history coding for neoplasms (e.g., metastatic disease with primary resected, patients on hormonal therapy like tamoxifen or aromatase inhibitors, etc.). Coding Clinic is the authoritative interpretive body recognized by CMS.
- ICD-10-CM Tabular instructional notes at category Z85 itself, which sit under the Z77–Z99 block "Persons with potential health hazards related to family and personal history."
If you want the primary source verbatim, the current Guidelines PDF is published annually around July–August by CDC/NCHS for the upcoming October 1 fiscal year and is the single best document to cite. Section I.C.21.c.4 has carried the same definition for years.
Bottom line
Z85.038 is not a "covers both" code. It is a resolved-disease code by official definition. If any malignant disease is still present anywhere in the body or under active treatment, the active C-code(s) apply, and Z85 is wrong — even if the chart note casually says "history of."
