ICD-10 Coding for Prostatic Adenocarcinoma(C61, D07.5)
Complete ICD-10-CM coding and documentation guide for Prostatic Adenocarcinoma. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prostatic Adenocarcinoma
C61Primary Range
Malignant neoplasm of prostate
Primary code for prostatic adenocarcinoma, representing the malignant neoplasm of the prostate.
Carcinoma in situ of prostate
Used for high-grade prostatic intraepithelial neoplasia (PIN III) without invasion.
Personal history of malignant neoplasm of prostate
Used for patients with a history of treated prostate cancer.
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 there is a confirmed diagnosis of adenocarcinoma of the prostate. |
|
| D07.5 | Carcinoma in situ of prostate | Use for high-grade PIN without evidence of invasion. |
|
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 prostatic adenocarcinoma
Essential facts and insights about Prostatic Adenocarcinoma
Primary ICD-10-CM Codes for prostatic adenocarcinoma
Decision Criteria
clinical Criteria
- Histological confirmation of adenocarcinoma
documentation Criteria
- Gleason score and PSA levels must be documented
Applicable To
- Adenocarcinoma of the prostate
Excludes
- Benign prostatic hyperplasia (N40.0)
Clinical Validation Requirements
- Histological confirmation of adenocarcinoma
- Gleason score documentation
- PSA levels
Code-Specific Risks
- Confusion with benign conditions like BPH
Coding Notes
- Ensure Gleason score and PSA levels are documented.
D07.5 - Carcinoma in situ of prostate
Use for high-grade PIN without evidence of invasion.
Applicable To
- High-grade prostatic intraepithelial neoplasia (PIN III)
Excludes
- Invasive adenocarcinoma of the prostate (C61)
Clinical Validation Requirements
- Biopsy report indicating PIN III
Coding Notes
Ensure biopsy report specifies PIN III.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Secondary malignant neoplasm of bone
C79.51Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Prostatic Adenocarcinoma to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code C61.
Impact
Clinical: Inadequate treatment planning., Regulatory: Non-compliance with clinical guidelines., Financial: Potential claim denials.
Mitigation Strategy
Standardize pathology report templates, Educate clinicians on documentation requirements
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Clearly specify PIN grade in biopsy reports.
Impact
Lack of histological confirmation can lead to audit issues.
Mitigation Strategy
Ensure all diagnoses are supported by biopsy reports.
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 Prostatic Adenocarcinoma, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prostatic Adenocarcinoma
Use these documentation templates to ensure complete and accurate documentation for Prostatic Adenocarcinoma. These templates include all required elements for proper coding and billing.
New diagnosis of prostatic adenocarcinoma
Specialty: OncologyRequired Elements
- Histological type
- Gleason score
- PSA levels
- Staging information
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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