ICD-10 Coding for Status Post Prostatectomy(Z98.52, Z90.79)
Complete ICD-10-CM coding and documentation guide for Status Post Prostatectomy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Status Post Prostatectomy
Z98-Z99Primary Range
Persons with potential health hazards related to family and personal history and certain conditions influencing health status
This range includes codes for postprocedural states, including status post prostatectomy.
Acquired absence of organs, not elsewhere classified
This range includes codes for acquired absence of genital organs, relevant for radical 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 |
|---|---|---|---|
| Z98.52 | Prostate removal status | Use for patients who have undergone a prostatectomy and are in post-operative management. |
|
| Z90.79 | Acquired absence of other genital organs | Use for patients who have undergone a radical prostatectomy with complete removal of the prostate. |
|
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 status post prostatectomy
Essential facts and insights about Status Post Prostatectomy
Primary ICD-10-CM Codes for status post prostatectomy
Decision Criteria
clinical Criteria
- Patient has undergone a prostatectomy with documented removal of the prostate.
Applicable To
- Status post prostatectomy
Excludes
- Z90.79 (Acquired absence of other genital organs)
Clinical Validation Requirements
- Operative report confirming prostatectomy
- PSA levels post-surgery
Code-Specific Risks
- Incorrectly using for TURP procedures
Coding Notes
- Ensure documentation supports the type of prostatectomy performed.
Z90.79 - Acquired absence of other genital organs
Use for patients who have undergone a radical prostatectomy with complete removal of the prostate.
Applicable To
- Status post radical prostatectomy
Excludes
- Z98.52 (Prostate removal status)
Clinical Validation Requirements
- Operative report indicating radical prostatectomy
- Pathology report confirming complete removal
Coding Notes
Ensure radical nature of surgery is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Status Post Prostatectomy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z98.52.
Impact
Clinical: Inadequate monitoring of recurrence risk., Regulatory: Non-compliance with follow-up care standards., Financial: Potential for denied claims due to incomplete documentation.
Mitigation Strategy
Regular PSA testing, Document PSA trends in follow-up visits
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate medical records and statistics.
Mitigation Strategy
Use Z98.890 for TURP status instead.
Impact
Using Z90.79 for non-radical prostatectomy procedures.
Mitigation Strategy
Verify surgical reports to confirm the type of prostatectomy.
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 Status Post Prostatectomy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Status Post Prostatectomy
Use these documentation templates to ensure complete and accurate documentation for Status Post Prostatectomy. These templates include all required elements for proper coding and billing.
Post-Prostatectomy Follow-Up
Specialty: UrologyRequired Elements
- Date of surgery
- Type of prostatectomy
- Current PSA levels
- Functional status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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