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C61
ICD-10-CM
Prostate Cancer with Metastasis

Find comprehensive information on Prostate Cancer with Metastasis, including clinical documentation, medical coding (ICD-10, ICD-11, SNOMED CT), staging (TNM), treatment options, and healthcare guidelines. Learn about bone metastasis, lymph node involvement, and distant metastases in prostate cancer. Explore resources for diagnosis, prognosis, and management of metastatic prostate cancer for healthcare professionals, patients, and caregivers.

Also known as

Metastatic Prostate Cancer
Prostate Adenocarcinoma with Metastasis

Diagnosis Snapshot

Key Facts
  • Definition : Prostate cancer that has spread beyond the prostate gland to other parts of the body.
  • Clinical Signs : Bone pain, fatigue, weight loss, urinary problems. Advanced disease may cause nerve damage.
  • Common Settings : Oncology clinics, radiation therapy centers, hospitals, and palliative care facilities.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC C61 Coding
C61

Malignant neoplasm of prostate

Cancer originating in the prostate gland.

C77-C79

Secondary malignant neoplasms of other sites

Cancer that has spread from the original site to other parts of the body.

Z85

Personal history of malignant neoplasm

Documentation of a past diagnosis of cancer, now resolved or in remission.

Code-Specific Guidance

Decision Tree for

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

Is the prostate cancer documented as metastatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Prostate cancer with metastasis
Localized prostate cancer
Prostate cancer, unspecified

Documentation Best Practices

Documentation Checklist
  • Prostate cancer metastasis: Site, date of diagnosis
  • Primary prostate cancer: Gleason score, TNM stage
  • Metastatic workup: Imaging, biopsy results, PSA levels
  • Treatment plan: Hormone therapy, chemotherapy, radiation
  • Performance status: ECOG, Karnofsky scores documented

Coding and Audit Risks

Common Risks
  • Metastasis Site Specificity

    Insufficient documentation of specific metastasis site(s) leading to inaccurate coding and potential underpayment. Impacts CDI, medical coding audits, and compliance.

  • Primary vs. Secondary

    Miscoding prostate cancer that metastasized TO the prostate AS primary prostate cancer. Affects accurate reporting, reimbursement, and healthcare compliance audits.

  • Lymph Node Involvement

    Lack of clear documentation regarding lymph node involvement (N stage) impacting accurate staging, medical coding, and subsequent treatment planning and compliance.

Mitigation Tips

Best Practices
  • Accurate ICD-10-CM coding (C61, C77-C79) for staging & met sites.
  • Precise CDI of metastasis location impacts treatment & HCC coding.
  • Timely pathology reports with confirmed diagnosis for NCCN guidelines.
  • Regular chart reviews ensure compliant & complete documentation.
  • Multidisciplinary team review for optimal care and code accuracy.

Clinical Decision Support

Checklist
  • Verify PSA level documented, ICD-10 C61, SNOMED CT 37287001
  • Confirm metastatic site documented, imaging report reviewed
  • Check bone scan report if bone metastasis suspected
  • Review biopsy pathology report, Gleason score documented
  • Ensure TNM staging documented, ICD-10 M8000/1, SNOMED CT

Reimbursement and Quality Metrics

Impact Summary
  • Prostate Cancer Metastasis Reimbursement: Coding accuracy impacts case mix index (CMI), directly affecting DRG assignment and hospital payments.
  • Quality Metrics Impact: Accurate coding of metastasis status (e.g., M0, M1) influences quality reporting metrics like survival rates and treatment efficacy.
  • Billing Compliance: Precise coding ensures appropriate reimbursement and minimizes risk of audits and denials for prostate cancer with metastasis.
  • Hospital Reporting: Correct staging data (TNM) crucial for cancer registry data, affecting hospital rankings and resource allocation.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code primary prostate cancer first
  • Use C77-C80 for mets sites
  • Document mets confirmation
  • Check 2024 ICD-10-CM updates
  • N stage impacts coding

Documentation Templates

Prostate cancer with metastasis has been confirmed in this patient.  Presenting symptoms include persistent bone pain, fatigue, and weight loss.  Initial evaluation revealed elevated prostate-specific antigen (PSA) levels exceeding 20 ngmL.  Digital rectal examination (DRE) demonstrated an enlarged, nodular prostate.  Subsequent imaging studies, including a bone scan and pelvic MRI, revealed metastatic lesions consistent with prostate cancer spread to the bone.  Biopsy of the prostate gland confirmed the diagnosis of adenocarcinoma of the prostate, Gleason score 8 (4+4).  Staging workup, including CT of the abdomen and pelvis, showed no evidence of visceral metastasis.  The patient's performance status is currently ECOG 1.  Treatment options including androgen deprivation therapy (ADT), chemotherapy, radiation therapy, and clinical trials were discussed with the patient.  Considering the patient's age, overall health status, and extent of disease, a treatment plan consisting of androgen deprivation therapy with luteinizing hormone-releasing hormone (LHRH) agonists was initiated.  Patient education regarding disease progression, potential treatment side effects including hot flashes, erectile dysfunction, and osteoporosis, and follow-up care was provided.  Referral to medical oncology and radiation oncology for further evaluation and consideration of additional treatment modalities has been made.  Continued monitoring of PSA levels, imaging studies, and symptom management will be essential.  The patient understands the diagnosis, prognosis, and treatment plan and is agreeable with the recommended course of action.  The patient will follow up in two weeks to assess treatment response and manage any potential side effects.  ICD-10 code C61 Malignant neoplasm of prostate and C79.51 Secondary malignant neoplasm of bone and bone marrow has been assigned.
Prostate Cancer with Metastasis - AI-Powered ICD-10 Documentation