What Is the ICD-10 Code for Prostate Cancer?

Prostate cancer is one of the most commonly diagnosed cancers in men, especially as they age. Whether a patient is undergoing screening, has just received a diagnosis, or is in follow-up care after treatment, proper documentation is essential not just for clinical accuracy but also for billing and insurance purposes.

If you’re wondering, “What is the ICD-10 code for prostate cancer?”, this post will guide you through everything you need to know, including when and how to use it in real-world scenarios.

The ICD-10 Code for Prostate Cancer

The official ICD-10-CM code for a confirmed diagnosis of prostate cancer is:

C61 – Malignant neoplasm of prostate

This code is used to indicate an active case of prostate cancer. It’s straightforward, billable, and widely accepted by payers across the healthcare system.

When Should You Use C61?

You should use C61 when:

• A confirmed diagnosis of prostate cancer has been made (e.g., via biopsy or imaging).

• The patient is currently receiving treatment such as surgery, radiation, hormone therapy, or active surveillance.

• The diagnosis is relevant to the visit or service provided.

For example:

A urologist seeing a patient for ongoing management of prostate cancer would report C61 as the primary diagnosis.

When NOT to Use C61

It’s important not to use this code if the patient does not currently have prostate cancer. As part of accurate medical billing and coding services, here are some situations where other ICD-10 codes are more appropriate:

This helps ensure that your billing accurately reflects the patient’s clinical condition and avoids denials from insurance companies.

Real-Life Coding Scenarios

Scenario 1: New Diagnosis

A patient undergoes a biopsy after elevated PSA levels. Results confirm prostate cancer. The provider documents the diagnosis and discusses treatment options.

Code: C61

Scenario 2: Prostate Cancer Screening

A 55-year-old male with no symptoms or history comes in for a routine prostate cancer screening.

Code: Z12.5

Scenario 3: Post-Treatment Monitoring

The patient completed radiation therapy a year ago and is now in remission. PSA levels are being monitored as part of follow-up.

Code: Z85.46

Scenario 4: Concern for Cancer, Not Yet Confirmed

A patient presents with urinary symptoms and a PSA of 10.0 ng/mL. The provider documents suspicion of prostate cancer and orders further testing.

Code: R97.2

Why Accurate ICD-10 Coding for Prostate Cancer Matters

Correctly assigning the ICD-10 code for prostate cancer is about more than just insurance claims. It impacts:

• Patient records and continuity of care

• Eligibility for specific treatments and trials

• Reimbursement for services provided

• Reporting for population health and quality metrics

Misusing codes especially assigning C61 when there is no confirmed diagnosis can lead to confusion, insurance denials, and potential compliance issues.

Tips for Providers and Medical Billers

• Always base coding on documentation. If prostate cancer is suspected but not confirmed, hold off on using C61 until you have a diagnosis.

• Update codes as the situation evolves. For example, switch from C61 to Z85.46 when a patient enters remission.

• Use supporting codes. For prostate cancer under treatment, you may also need to include codes for treatment complications, related symptoms, or procedures like TURP or radiation therapy.

Summary

To answer the question simply:

The ICD-10 code for prostate cancer is C61 – Malignant neoplasm of prostate.

It should only be used when there’s a confirmed diagnosis, and it plays a crucial role in treatment planning, insurance processing, and overall patient care. For cases involving screening, elevated PSA, ICD 10 for leukocytosis, or history of prostate cancer, make sure to choose the correct alternate codes to ensure accuracy and compliance.