The ICD-10 code for prostate cancer is used to document and report malignant neoplasms of the prostate gland. Accurate coding is essential for oncology care, medical billing, claims reimbursement, cancer registry reporting, and treatment planning.
Prostate cancer is one of the most common cancers in men, making correct ICD-10-CM code selection critical across inpatient, outpatient, and specialty care settings.
ICD Code Description
Primary ICD-10-CM Code: C61
Diagnosis: Malignant neoplasm of prostate
The ICD-10-CM code C61 applies when a patient has an active diagnosis of prostate cancer, regardless of stage or histologic type, unless a more specific neoplasm-related code is required.
Clinical Specificity
- Condition: Malignant neoplasm
- Anatomical site: Prostate gland
- Laterality: Not applicable
- Acuity: Active malignancy
- Severity/Stage: Not specified in ICD-10-CM
ICD-10-CM does not differentiate prostate cancer by stage or grade for diagnosis coding.
Category & Code Type
ICD-10-CM Chapter
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Chapter 2: Neoplasms (C00–D49)
ICD-10 Category
-
C61 – Malignant neoplasm of prostate
Code Type
- C61 is a billable and specific ICD-10-CM code
- Valid for reimbursement in all care settings
Includes / Excludes Notes
Includes:
- Prostate adenocarcinoma
- Malignant tumor of the prostate
- Primary prostate cancer
Excludes:
- Carcinoma in situ of prostate (D07.5)
- Benign prostatic hyperplasia (BPH) (N40.-)
- History of prostate cancer (Z85.46)
- Secondary malignant neoplasm of prostate (use appropriate C77–C79 codes if applicable)
Coding Guidelines
Key ICD-10-CM coding rules for prostate cancer include:
- Use C61 for active prostate cancer
- Continue coding C61 while the patient is receiving treatment (surgery, radiation, chemotherapy, hormone therapy)
- After treatment is complete and no active disease is present, use Z85.46 (Personal history of malignant neoplasm of prostate)
- Code metastatic sites separately when documented
- Do not code suspected or rule-out cancer in outpatient settings
Billing Considerations
Reimbursement Impact
- Supports billing for oncology visits, imaging, biopsies, surgery, radiation, and systemic therapies
- Impacts risk adjustment, case mix, and severity reporting
Payer Considerations
- Payers require clear documentation of active malignancy vs. history
- Ongoing treatment supports continued use of C61
- Metastatic disease may require additional diagnosis codes
Documentation Tips
To support accurate prostate cancer coding, documentation should include:
- Confirmation of malignant prostate cancer diagnosis
- Current disease status (active, under treatment, recurrent)
- Treatment plan and therapy type
- Evidence of metastasis, if present
- Clinical notes differentiating history vs. active disease
Avoid using C61 for patients in long-term remission with no active treatment.
Common Clinical Examples
- Newly diagnosed prostate cancer following biopsy
- Active prostate cancer treated with radiation therapy
- Ongoing hormone therapy for malignant prostate neoplasm
- Hospital admission related to complications of prostate cancer treatment
Common Errors & Denials
Frequent mistakes include:
- Coding C61 for a personal history of prostate cancer
- Failing to code metastatic sites
- Confusing BPH with prostate cancer
- Using neoplasm codes without definitive diagnosis
These errors may lead to claim denials or audit risk.
Key Takeaways
- C61 is the ICD-10-CM code for active prostate cancer
- It is a billable diagnosis code under the Neoplasms chapter
- Use Z85.46 when cancer is no longer active
- Code metastases separately when present
- Clear documentation is essential for accurate billing and reporting
FAQ
What is the ICD-10 code for prostate cancer?
The correct ICD-10-CM code is C61.
Is C61 a billable diagnosis code?
Yes, C61 is billable and valid for reimbursement.
When should C61 no longer be used?
When treatment has ended and there is no active disease, use Z85.46 instead.
Does ICD-10 code prostate cancer by stage or Gleason score?
No. ICD-10-CM does not classify prostate cancer by stage or grade.
Should metastases be coded separately?
Yes. Documented metastatic sites require additional secondary malignancy codes.
