ICD-10 Coding for Prostatectomy(C61, N40.0)
Complete ICD-10-CM coding and documentation guide for Prostatectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prostatectomy
C61Primary Range
Malignant neoplasm of prostate
Primary code for prostate cancer requiring prostatectomy.
Diseases of male genital organs
Includes benign prostatic hyperplasia (BPH) related procedures.
Persons with potential health hazards related to family and personal history and certain conditions influencing health status
Used for documenting acquired absence of prostate post-prostatectomy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| C61 | Malignant neoplasm of prostate | Use when pathology confirms prostate cancer. |
|
| N40.0 | Benign prostatic hyperplasia with lower urinary tract symptoms | Use for BPH cases requiring surgical intervention. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for prostatectomy
Essential facts and insights about Prostatectomy
Primary ICD-10-CM Codes for prostatectomy
Decision Criteria
clinical Criteria
- Confirmed prostate cancer diagnosis
Applicable To
- Adenocarcinoma of prostate
Excludes
- Benign prostatic hyperplasia (N40.0)
Clinical Validation Requirements
- PSA >10 ng/mL
- Positive biopsy for adenocarcinoma
Code-Specific Risks
- Incorrect staging documentation
Coding Notes
- Ensure Gleason score and staging are documented.
N40.0 - Benign prostatic hyperplasia with lower urinary tract symptoms
Use for BPH cases requiring surgical intervention.
Applicable To
- BPH with LUTS
Excludes
- Prostate cancer (C61)
Clinical Validation Requirements
- IPSS score >19
- Prostate volume >80g
Coding Notes
Document IPSS and prostate size.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Prostatectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C61.
Impact
Clinical: Affects treatment decisions, Regulatory: Non-compliance with cancer reporting standards, Financial: Potential claim denials
Mitigation Strategy
Use standardized pathology templates, Double-check reports before submission
Impact
Reimbursement: Incorrect bundling may lead to denied claims., Compliance: Violates coding guidelines for procedure bundling., Data Quality: Leads to inaccurate procedural data.
Mitigation Strategy
Use only one code if lymphadenectomy is included.
Impact
Incomplete documentation of surgical procedures.
Mitigation Strategy
Implement comprehensive operative note templates.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Prostatectomy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prostatectomy
Use these documentation templates to ensure complete and accurate documentation for Prostatectomy. These templates include all required elements for proper coding and billing.
Prostatectomy for BPH
Specialty: UrologyRequired Elements
- Procedure details
- Indication
- Findings
- Specimens
- Complications
- Post-op plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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