2024 ICD-10-CM Diagnosis Code C61

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Acinar cell cystadenocarcinoma of prostate
• Adenocarcinoma of prostate
• Carcinoma of prostate
• Endometrioid carcinoma of prostate
• Extraprostatic extension of tumor present
• Extraprostatic extension of tumor present, focal
• Extraprostatic extension of tumor present, multifocal
• Extraprostatic extension of tumor present, non-focal
• Extraprostatic extension of tumor present, unifocal
• Familial prostate cancer
• Hormone refractory prostate cancer
• Hormone sensitive prostate cancer
• Infiltrating duct carcinoma of prostate
• Local recurrence of malignant tumor of prostate
• Malignant tumor involving an organ by direct extension from prostate
• Malignant tumor involving bladder by direct extension from prostate
• Malignant tumor involving rectum by direct extension from prostate
• Malignant tumor involving seminal vesicle by direct extension from prostate
• Malignant tumor involving urethra by direct extension from prostate
• Malignant tumor involving vasa deferentia by direct extension from prostate
• Malignant tumor of prostate
• Malignant tumor of seminal vesicle
• Metastatic castration-resistant prostate cancer
• Metastatic castration-resistant prostate cancer
• Non-metastatic prostate cancer
• Obstructive nephropathy due to malignancy
• Obstructive nephropathy due to prostate cancer
• Primary acinar cell cystadenocarcinoma of prostate
• Primary adenocarcinoma of prostate
• Primary carcinoma of prostate
• Primary endometrioid carcinoma of prostate
• Primary infiltrating duct carcinoma of prostate
• Primary malignant hormone-refractory neoplasm of prostate
• Primary malignant neoplasm of prostate
• Primary malignant neoplasm of prostate
• Primary small cell carcinoma of prostate
• Prostate cancer metastatic to eye
• Recurrent malignant neoplasm of prostate
• Small cell carcinoma of prostate
• Squamous cell carcinoma of male genital
• Squamous cell carcinoma of prostate
• Tumor invasion of perineural tissue absent
• Tumor invasion of perineural tissue present
• Tumor invasion of periprostatic fat absent
• Tumor of seminal vesicle

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

• Diagnoses for males only - The Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, these edits apply to MALES only .

C61 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
715	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC	12	2.2075
716	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC	12	1.4222

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert C61 to ICD-9-CM

• ICD-9-CM Code: 185 - Malign neopl prostate

Quality Payment Program Measures

When code C61 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.

Quality Measure	Description	Quality Domain	Measure Type	High Priority	Submission Methods
Radical Prostatectomy Pathology Reporting	Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.	Effective Clinical Care	Process	NO	Claims, Registry

Table of Neoplasms

This code is referenced in the table of neoplasms by anatomical site. For each site there are six possible code numbers according to whether the neoplasm in question is malignant, benign, in situ, of uncertain behavior, or of unspecified nature. The description of the neoplasm will often indicate which of the six columns is appropriate.

Where such descriptors are not present, the remainder of the Index should be consulted where guidance is given to the appropriate column for each morphological (histological) variety listed. However, the guidance in the Index can be overridden if one of the descriptors mentioned above is present.

Filter table of neoplasms:

Neoplasm, neoplastic	Malignant Primary	Malignant Secondary	CaInSitu	Benign	Uncertain Behavior	Unspecified Behavior
»Neoplasm, neoplastic   »prostate (gland)	C61	C79.82	D07.5	D29.1	D40.0	D49.59

Patient Education

Prostate Cancer

What is prostate cancer?

Cancer is a disease in which cells in the body grow out of control. Prostate cancer begins in the cells of the prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

Prostate cancer is one of the most common types of cancer. It often grows very slowly. If it does not spread to other parts of the body, it may not cause serious problems. But sometimes prostate cancer can grow quickly and spread to other parts of the body. This kind of prostate cancer is serious.

What causes prostate cancer?

Researchers don't know for sure what causes prostate cancer. They do know that it happens when there are changes in the genetic material (DNA).

Sometimes these genetic changes are inherited, meaning that you are born with them. There are also certain genetic changes that happen during your lifetime that can raise your risk of prostate cancer. But often the exact cause of these genetic changes is unknown.

Who is more likely to develop prostate cancer?

Anyone who has a prostate can develop prostate cancer. But certain factors can make you more likely to develop it:

• Age. Your chance of developing prostate cancer increases as you get older. Prostate cancer is rare in people under age 50.
• Family health history. Your risk of prostate cancer is higher if you have a parent, sibling, or child who has or has had prostate cancer.
• Race. African Americans are more likely to get prostate cancer. They're also more likely to:
  • Get prostate cancer at a younger age.
  • Have more serious prostate cancer.
  • Die from prostate cancer.

What are the symptoms of prostate cancer?

Prostate cancer doesn't always cause symptoms, especially at first. If it does cause symptoms, they may include:

• Problems urinating (peeing), such as:
  • A urine stream that's weak, hard to start, or starts and stops
  • Suddenly needing to urinate right away
  • Urinating often, especially at night
  • Pain or burning when urinating
  • Blood in your urine or semen
• Pain in your lower back, hips, or pelvis that does not go away
• Painful ejaculation (the release of semen through the penis during orgasm)

But many of these symptoms may be from other common prostate problems that aren't cancer, such as an enlarged prostate.

You should discuss your prostate health with your health care provider if you:

• Have symptoms that could be prostate cancer
• Have a high risk for developing prostate cancer
• Had a screening test that suggests you could have prostate cancer

What are prostate tests and how is prostate cancer diagnosed?

Tests which check for prostate cancer include:

• A digital rectal exam (DRE). In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
• A prostate-specific antigen (PSA) blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
• Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.

If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.

During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.

What are the treatments for prostate cancer?

Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more of options:

• Observation,which is mostly used if you are older, your prostate cancer isn't likely to grow quickly, and you don't have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
  • Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
  • Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
• Surgery to remove your prostate gland may be an option if your cancer hasn't spread outside of your prostate.
• Radiation therapy uses high energy to kill cancer cells or prevent them from growing.
• Hormone therapy blocks cancer cells from getting the hormones they need to grow. It may include taking medicines or having surgery to remove the testicles.
• Chemotherapy uses medicines to kill cancer cells, slow their growth, or stop them from spreading. You might take the drugs by mouth, as an injection (shot), as a cream, or intravenously (by IV).
• Targeted therapy uses drugs or other substances that attack specific cancer cells. This treatment causes less harm to healthy cells than radiation therapy or chemotherapy.
• Immunotherapy helps your own immune system to fight cancer.

Can prostate cancer be prevented?

Making healthy lifestyle changes may help to prevent some prostate cancers. These changes include:

• Being at a healthy weight
• Quitting smoking
• Getting enough exercise
• Eating healthy foods

NIH: National Cancer Institute

[Learn More in MedlinePlus]

Prostate cancer

Prostate cancer is a common disease that affects men, usually in middle age or later. In this disorder, certain cells in the prostate become abnormal, multiply without control or order, and form a tumor. The prostate is a gland that surrounds the male urethra and helps produce semen, the fluid that carries sperm.

Early prostate cancer usually does not cause pain, and most affected men exhibit no noticeable symptoms. Men are often diagnosed as the result of health screenings, such as a blood test for a substance called prostate specific antigen (PSA) or a medical exam called a digital rectal exam (DRE). As the tumor grows larger, signs and symptoms can include difficulty starting or stopping the flow of urine, a feeling of not being able to empty the bladder completely, blood in the urine or semen, or pain with ejaculation. However, these changes can also occur with many other genitourinary conditions. Having one or more of these symptoms does not necessarily mean that a man has prostate cancer.

The severity and outcome of prostate cancer varies widely. Early-stage prostate cancer can usually be treated successfully, and some older men have prostate tumors that grow so slowly that they may never cause health problems during their lifetime, even without treatment. In other men, however, the cancer is much more aggressive; in these cases, prostate cancer can be life-threatening.

Some cancerous tumors can invade surrounding tissue and spread to other parts of the body. Tumors that begin at one site and then spread to other areas of the body are called metastatic cancers. The signs and symptoms of metastatic cancer depend on where the disease has spread. If prostate cancer spreads, cancerous cells most often appear in the lymph nodes, bones, lungs, liver, or brain.

A small percentage of prostate cancers are hereditary and occur in families. These hereditary cancers are associated with inherited gene variants. Hereditary prostate cancers tend to develop earlier in life than non-inherited (sporadic) cases.

[Learn More in MedlinePlus]

Prostate Cancer Summary

Learn about prostate cancer symptoms, tests to diagnose, factors affecting prognosis, staging, and treatment.
[Learn More in MedlinePlus]

Prostate Cancer Treatment (PDQ®)

Learn about prostate cancer symptoms, tests to diagnose, factors affecting prognosis, staging, and treatment.
[Learn More in MedlinePlus]

Prostate Tests

Learn about tests used to identify prostate problems, such as DRE, PSA test, prostate health index, and a transrectal ultrasound with prostate biopsy.
[Learn More in MedlinePlus]

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.