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C61
ICD-10-CM
Prostate Cancer

Find comprehensive information on prostate cancer diagnosis including ICD-10 codes C61, N73.2, and related SNOMED CT concepts. Learn about Gleason score, PSA levels, DRE findings, transrectal ultrasound, biopsy procedures, and staging for accurate clinical documentation and medical coding. Explore healthcare resources for prostate cancer treatment, management, and prognosis. This resource supports physicians, coders, and healthcare professionals seeking accurate and efficient documentation of prostate cancer.

Also known as

Prostatic Neoplasm
Malignant Neoplasm of Prostate
Cancer of Prostate
+5 more

Diagnosis Snapshot

Key Facts
  • Definition : Malignant tumor of the prostate gland, commonly affecting older men.
  • Clinical Signs : Urinary issues (frequency, urgency, weak stream), erectile dysfunction, back pain.
  • Common Settings : Urology clinic, primary care physician, cancer center.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC C61 Coding
C61

Malignant neoplasm of prostate

Cancer originating in the prostate gland.

M8000/3

Primary malignant neoplasm

Identifies the prostate as the primary cancer site.

Z85.46

Personal history of prostate cancer

Indicates a past diagnosis of prostate cancer, now resolved.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the prostate cancer confirmed by pathology?

  • Yes

    Is there metastasis?

  • No

    Do not code prostate cancer. Code the signs/symptoms or reason for encounter.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Prostate cancer
Benign prostatic hyperplasia
Prostatitis

Documentation Best Practices

Documentation Checklist
  • Prostate cancer diagnosis documentation checklist
  • ICD-10 code C61, clinical findings, Gleason score
  • PSA levels, DRE findings, imaging results (MRI, bone scan)
  • Biopsy results, tumor stage (TNM), treatment plan
  • Prostatectomy, radiation therapy, hormone therapy documentation

Coding and Audit Risks

Common Risks
  • Laterality Coding

    Incomplete documentation of laterality (right, left, bilateral) for prostate cancer can lead to coding errors and inaccurate reporting.

  • Gleason Score Miscoding

    Incorrect assignment or documentation of the Gleason score can impact risk stratification and treatment coding for prostate cancer.

  • Clinical Staging Accuracy

    Discrepancies between clinical staging and pathological staging of prostate cancer may result in incorrect coding and reimbursement issues.

Mitigation Tips

Best Practices
  • Accurate ICD-10-CM/PCS prostate cancer coding for optimal reimbursement.
  • Complete clinical documentation improves prostate cancer diagnosis specificity.
  • Timely pathology reports crucial for accurate prostate cancer staging & treatment.
  • Regular CDI audits ensure compliant prostate cancer documentation & coding.
  • Standardized vocabulary use improves prostate cancer data analysis & research.

Clinical Decision Support

Checklist
  • Verify PSA level and DRE findings documented (ICD-10 C61, N42.3)
  • Confirm family history, age, race documented for risk (SNOMED CT 22637001)
  • Check if biopsy performed and Gleason score recorded (ICD-10 C61)
  • Review imaging results (MRI, bone scan) if available (CPT 72195, 78300)
  • Ensure shared decision-making regarding treatment documented

Reimbursement and Quality Metrics

Impact Summary
  • Prostate Cancer Reimbursement: Coding accuracy impacts CMI, RVUs, and denials. Proper ICD-10-CM (C61) and CPT coding maximizes reimbursement.
  • Quality Metrics Impact: Prostate cancer staging (TNM) accuracy affects quality reporting, pay-for-performance programs, and hospital rankings.
  • Hospital Reporting: Accurate documentation and coding of Gleason score and PSA levels are crucial for quality cancer registry data and outcomes analysis.
  • Coding Accuracy Tip: Distinguish between screening (Z12.5) and diagnostic (N40) prostate biopsies for correct claim submission and reimbursement.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code confirmed PCa C61
  • Use Z12.5 for screening
  • Document Gleason score
  • Add laterality and TNM
  • Note PSA and DRE findings

Documentation Templates

Prostate cancer diagnosis confirmed in a [Age] year-old male patient presenting with [Symptoms, e.g., lower urinary tract symptoms, erectile dysfunction, back pain].  Digital rectal examination revealed [DRE findings, e.g., an enlarged, firm, or nodular prostate].  Prostate-specific antigen (PSA) level measured [PSA value] ngmL.  Transrectal ultrasound (TRUS) guided biopsy of the prostate was performed, and histopathological analysis revealed [Gleason score] adenocarcinoma of the prostate.  Staging workup, including bone scan and CT scan of the abdomen and pelvis, was conducted to assess the extent of disease and determine appropriate prostate cancer treatment.  The TNM staging is currently [TNM stage].  Differential diagnoses considered included benign prostatic hyperplasia (BPH), prostatitis, and other urological conditions.  Treatment options discussed with the patient include active surveillance, radical prostatectomy, radiation therapy (external beam radiation therapy or brachytherapy), hormone therapy (androgen deprivation therapy), and chemotherapy.  Patient education regarding prostate cancer prognosis, side effects of treatment, and follow-up care was provided.  Referral to urology and oncology for further management and shared decision-making regarding prostate cancer treatment plan.  Medical coding will utilize ICD-10 code C61 for malignant neoplasm of the prostate and relevant CPT codes for procedures performed, including biopsy, imaging, and consultations.  This documentation supports medical billing for services rendered. The patient will continue to be monitored for prostate cancer recurrence and treatment-related complications.