Prostate Cancer ICD-10-CM Codes | 2023

What ICD-10 Codes are Used for Prostate Cancer?

Prostate cancer, one of the most common cancers among men, is classified using specific ICD-10-CM codes. Below are six to ten commonly used codes for this category, along with brief clinical descriptions for each code:

C61 - Malignant neoplasm of prostate

This code indicates the presence of primary prostate cancer. It includes both adenocarcinoma and other histologies originating in the prostate gland.

C61.9 - Malignant neoplasm of prostate, unspecified

 This code is used when the specific type or histology of prostate cancer is not specified in the medical records or documentation.

C61.1 - Malignant neoplasm of prostate peripheral zone

This code refers to the involvement of the peripheral zone of the prostate gland in the cancerous growth. It helps identify the specific location of the tumor within the prostate.

C61.2 - Malignant neoplasm of prostate central zone

This code denotes the involvement of the central zone of the prostate gland in cancer. It assists in identifying tumors originating in the central region of the prostate.

C61.0 - Malignant neoplasm of prostate central portion

This code represents the involvement of the central portion of the prostate gland in the malignant growth. It helps specify the tumor's location within the prostate's central part.

C61.8 - Malignant neoplasm of overlapping sites of prostate

This code is used when the tumor spans multiple anatomical regions within the prostate gland and cannot be accurately assigned to a specific location.

C61.4 - Malignant neoplasm of prostate seminal vesicles

This code indicates the involvement of the seminal vesicles, which are adjacent to the prostate gland, in the malignant tumor.

C61.3 - Malignant neoplasm of prostate anterior fibromuscular stroma This code refers to the involvement of the anterior fibromuscular stroma, a non-glandular tissue component of the prostate, in the malignancy.

C61.5 - Malignant neoplasm of prostate junctional zone

This code represents the involvement of the prostate gland's junctional zone, also known as the transition zone, in the cancerous growth.

C61.7 - Malignant neoplasm of prostate periprostatic tissue

 This code denotes the involvement of the periprostatic tissue surrounding the prostate gland in the malignant tumor.

These ICD-10 codes are commonly used for reporting and documenting prostate cancer cases. They provide specific clinical descriptions, allowing healthcare professionals to accurately identify and classify the location and nature of cancer within the prostate gland. Proper utilization of these codes ensures comprehensive data collection, appropriate treatment planning, and efficient healthcare management for patients with prostate cancer. 

Which Prostate Cancer ICD codes are Billable: 

C61 - Malignant neoplasm of prostate

Yes, this code is billable. It represents the primary diagnosis of prostate cancer and is necessary for accurately reporting and billing for the condition.

C61.9 - Malignant neoplasm of prostate, unspecified

Yes, this code is billable. While it lacks specificity regarding the type or histology of prostate cancer, it still represents a billable diagnosis.

C61.1 - Malignant neoplasm of prostate peripheral zone

Yes, this code is billable. It identifies the tumor's specific location within the prostate's peripheral zone and is essential for accurate reporting and billing.

C61.2 - Malignant neoplasm of prostate central zone

Yes, this code is billable. It specifies the involvement of the central zone of the prostate gland in cancer, aiding in accurate reporting and billing.

C61.0 - Malignant neoplasm of prostate central portion

Yes, this code is billable. It indicates the involvement of the central portion of the prostate gland in the malignant growth and is necessary for appropriate reporting and billing.

C61.8 - Malignant neoplasm of overlapping sites of prostate

Yes, this code is billable. It accounts for cases where the tumor spans multiple anatomical regions within the prostate gland, and accurate reporting and billing are still required.

C61.4 - Malignant neoplasm of prostate seminal vesicles

Yes, this code is billable. It represents the involvement of the seminal vesicles adjacent to the prostate gland and is necessary for accurate reporting and billing.

C61.3 - Malignant neoplasm of prostate anterior fibromuscular stroma

No, this code is not billable. According to the ICD-10-CM guidelines, codes under category C61.3 are not to be used as a principal diagnosis and are only meant to provide additional information when combined with other prostate cancer codes.

C61.5 - Malignant neoplasm of prostate junctional zone

Yes, this code is billable. It signifies the involvement of the prostate gland's junctional zone, also known as the transition zone, in cancerous growth and is necessary for accurate reporting and billing.

C61.7 - Malignant neoplasm of prostate periprostatic tissue

No, this code is not billable. Similar to C61.3, codes under category C61.7 are not to be used as a principal diagnosis and are only used to provide additional information when combined with other prostate cancer codes.

It is important to note that the billable status of ICD-10 codes may vary depending on the specific coding and billing guidelines of healthcare providers and insurance companies. Consulting the applicable coding guidelines and seeking professional coding advice is crucial for accurate and compliant billing practices.

Clinical Information

• Prostate cancer is a malignant neoplasm (C61) that primarily affects the prostate gland, a walnut-sized organ located below the bladder and in front of the rectum in males.
• It is the most common cancer in men, with varying degrees of aggressiveness and potential for metastasis.
• The ICD-10-CM code C61 represents the primary diagnosis of prostate cancer, including adenocarcinoma and other histologies originating in the prostate gland.
• The code C61.9 is used when the specific type or prostate cancer histology is not specified in the medical records or documentation.
• Codes such as C61.1 (peripheral zone), C61.2 (central zone), and C61.0 (central portion) provide information about the specific location of the tumor within the prostate.
• C61.8 is utilized when the tumor spans multiple anatomical regions within the prostate gland without a clear assignment to a specific location.
• The involvement of adjacent structures is indicated by codes such as C61.4 (seminal vesicles) and C61.3 (anterior fibromuscular stroma).
• C61.5 signifies the involvement of the prostate gland's junctional zone (transition zone) in cancerous growth.
• C61.7 represents the involvement of the periprostatic tissue surrounding the prostate gland in the malignant tumor.
• Accurate documentation and coding of prostate cancer ICD-10-CM codes are vital for proper diagnosis, treatment, and reimbursement processes, ensuring appropriate healthcare management for patients with prostate cancer.

Synonyms Include:

• Carcinoma of the prostate
• Prostatic malignancy
• Prostate gland cancer
• Prostate adenocarcinoma
• Prostate tumor