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ICD10BillableValid for clinical use

ICD-10 Code Z91.49: Other personal history of psychological trauma, not elsewhere classified

Z91.49 is a billable ICD-10 diagnosis code used to classify Other personal history of psychological trauma, not elsewhere classified in medical records and claims. You may see this code in hospital records, discharge summaries, insurance claims, encounter documentation, referrals, or other healthcare billing and coding records. ICD-10 codes are diagnosis classification codes used in healthcare records, reporting, coding workflows, and billing support. This code sits within the broader ICD-10 area for Factors influencing health status and contact with health services (Z00-Z99).

What is this code?

ICD-10 codes are diagnosis classification codes used in healthcare records, reporting, coding workflows, and billing support. This code sits within the broader ICD-10 area for Factors influencing health status and contact with health services (Z00-Z99).

When is it used?

  • May be used when a clinician documents other personal history of psychological trauma, not elsewhere classified in a patient's medical record.
  • May appear in hospital records, claims, referrals, and clinical documentation.
  • This code can be used as a clinically usable diagnosis entry in standardized coding workflows.

What it does not mean

  • A code alone does not explain severity, treatment plan, or outcome.
  • A medical code should not be treated as a substitute for a doctor's diagnosis or advice.

Code hierarchy

chapter
21Factors influencing health status and contact with health services (Z00-Z99)
block
Z77-Z99Persons with potential health hazards related to family and personal history and certain conditions influencing health status
category
Z91Personal risk factors, not elsewhere classified
category
Z91.4Personal history of psychological trauma, not elsewhere classified
currentZ91.4

Where you may see this code

You may see this code in hospital records, discharge summaries, insurance claims, encounter documentation, referrals, or other healthcare billing and coding records.

Related specialists

General PhysicianOrthopedic SpecialistPsychiatristClinical Psychologist

Coverage-related procedures and services

CPT 96105high
ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT, PER HOUR
Source: CMS coverage guidance
HCPCS G0451high
DEVELOPMENT TESTING, WITH INTERPRETATION AND REPORT, PER STANDARDIZED INSTRUMENT FORM
Source: CMS coverage guidance
CPT 96113high
DEVELOPMENTAL TEST ADMINISTRATION (INCLUDING ASSESSMENT OF FINE AND/OR GROSS MOTOR, LANGUAGE, COGNITIVE LEVEL, SOCIAL, MEMORY AND/OR EXECUTIVE FUNCTIONS BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS WHEN PERFORMED), BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WITH INTERPRETATION AND REPORT; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
Source: CMS coverage guidance
CPT 96112high
DEVELOPMENTAL TEST ADMINISTRATION (INCLUDING ASSESSMENT OF FINE AND/OR GROSS MOTOR, LANGUAGE, COGNITIVE LEVEL, SOCIAL, MEMORY AND/OR EXECUTIVE FUNCTIONS BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS WHEN PERFORMED), BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WITH INTERPRETATION AND REPORT; FIRST HOUR
Source: CMS coverage guidance
CPT 90870high
ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING)
Source: CMS coverage guidance
CPT 90847high
FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MINUTES
Source: CMS coverage guidance

Coding guidelines

Common synonyms

Other personal history of psychological trauma, not elsewhere classified

Frequently asked questions

Code details

CodeZ91.49
SystemICD10
Display nameOther personal history of psychological trauma, not elsewhere classified
ChapterFactors influencing health status and contact with health services (Z00-Z99)
BlockPersons with potential health hazards related to family and personal history and certain conditions influencing health status

Flags

BillableYes
Valid clinical useYes

Source

SourceICD-10
Version2026-annual
Releaseannual
Year2026

Index terms

Matched terms
HistoryHistory

About this content

This page is prepared by HealthAssure's clinical team using official coding standards from ICD-10. AI tools assist with drafting explanations, which are then reviewed and verified by healthcare professionals for accuracy. This content is for informational purposes and does not replace professional medical advice. Meet our team.