Z12.5 – Encounter for screening for malignant neoplasm of prostate

Z12.5 Diagnosis Code: Encounter for screening for malignant neoplasm of prostate

The ICD-10-CM code Z12.5 represents the encounter for screening for malignant neoplasm of the prostate. This code is used when a patient seeks medical attention to undergo prostate cancer screening. Here are key points about this diagnosis code:

• The primary purpose of using code Z12.5 is to encourage early detection and diagnosis of prostate cancer through routine screening.
• This code applies to asymptomatic patients and those without known prostate-related symptoms.
• The encounter can occur in various healthcare settings, such as primary care offices, urology clinics, or specialized cancer centers.
• Screening methods for prostate cancer include digital rectal examination (DRE), prostate-specific antigen (PSA) testing, or a combination of both.
• The code should not be used for diagnostic evaluations or follow-up of confirmed prostate cancer cases.

Is Z12.5 Billable: Yes

Yes, the Z12.5 code is billable. Insurance providers typically cover preventive services like prostate cancer screening, including the associated evaluation and management visit. However, verifying coverage with individual insurance plans and adhering to their specific guidelines is important.

Clinical Information

• Prostate cancer is the most common cancer in males and the second leading cause of cancer-related deaths among men in some regions.
• Risk factors for prostate cancer include age (increasing incidence with older age), family history, African-American ethnicity, and certain genetic mutations.
• Routine screening for prostate cancer typically involves digital rectal examination (DRE) and prostate-specific antigen (PSA) testing.
• The American Cancer Society recommends discussing the potential benefits and limitations of screening patients to facilitate informed decision-making.
• PSA screening may have limitations, including the potential for false positives or false negatives, leading to further evaluations, such as prostate biopsies.
• Early detection through screening allows for timely treatment and may improve the chances of successful outcomes for prostate cancer patients.

Synonyms Include:

• Encounter for screening for malignant neoplasm of the prostate
• Screening for prostate cancer
• Prostate cancer screening
• Prostate cancer screening visit
• Screening exam for prostate cancer

Other ICD-10 Codes Commonly Used for Encounter for Screening

Here are commonly used ICD-10 codes related to the encounter for screening for prostate cancer:

• R97.21 - Elevated prostate-specific antigen [PSA]
• Z85.46 - Personal history of malignant neoplasm of prostate
• Z80.42 - Family history of malignant neoplasm of prostate
• Z01.411 - Encounter for gynecological examination (general) (routine) with abnormal findings
• Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings
• Z12.2 - Encounter for screening for malignant neoplasm of skin
• Z12.31 - Encounter for screening for malignant neoplasm of bladder
• Z12.39 - Encounter for screening for other malignant neoplasms of urinary organs
• Z12.72 - Encounter for screening for malignant neoplasm of rectum