C61 - Malignant neoplasm of prostate

Version 2023

ICD-10:	C61
Short Description:	Malignant neoplasm of prostate
Long Description:	Malignant neoplasm of prostate
Status:	Valid for Submission
Version:	ICD-10-CM 2023
Code Classification:	Neoplasms (C00–D48) Malignant neoplasms of male genital organs (C60-C63) Malignant neoplasm of prostate (C61)

1. Approximate Synonyms
2. Tabular List of Diseases and Injuries
3. Index to Diseases and Injuries References
4. Code Edits
5. Diagnostic Related Groups - MS-DRG Mapping
6. Convert to ICD-9 Code
7. Quality Payment Program Measures
8. Table of Neoplasms
9. Patient Education
10. Code History

C61 is a billable ICD-10 code used to specify a medical diagnosis of malignant neoplasm of prostate. The code is valid during the fiscal year 2023 from October 01, 2022 through September 30, 2023 for the submission of HIPAA-covered transactions.

This code is applicable to male patients only. It is clinically and virtually impossible to use this code on a non-male patient.

The following anatomical sites found in the Table of Neoplasms reference this diagnosis code given the correct histological behavior: Neoplasm, neoplastic prostate (gland) .

The code is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Radical Prostatectomy Pathology Reporting.

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 an organ by separate metastasis from prostate
Malignant tumor involving bladder by direct extension from prostate
Malignant tumor involving bladder by separate metastasis from prostate
Malignant tumor involving rectum by direct extension from prostate
Malignant tumor involving rectum by separate metastasis from prostate
Malignant tumor involving seminal vesicle by direct extension from prostate
Malignant tumor involving seminal vesicle by separate metastasis from prostate
Malignant tumor involving urethra by direct extension from prostate
Malignant tumor involving urethra by separate metastasis from prostate
Malignant tumor involving vasa deferentia by direct extension from prostate
Malignant tumor involving vasa deferentia by separate metastasis from prostate
Malignant tumor of prostate
Malignant tumor of seminal vesicle
Malignant tumor of seminal vesicle
Malignant tumor of spermatic cord
Metastasis from malignant tumor of prostate
Metastatic castration-resistant prostate cancer
Neoplasm of prostate distant metastasis staging category M0: No distant metastasis
Neoplasm of prostate distant metastasis staging category M1: Distant metastasis
Neoplasm of prostate distant metastasis staging category M1a: Metastasis to nonregional lymph node
Neoplasm of prostate distant metastasis staging category M1b: Metastasis to bone
Neoplasm of prostate distant metastasis staging category M1c: Distant metastasis with or without metastasis to bone
Neoplasm of prostate primary tumor staging category pT3a: Extraprostatic extension or microscopic invasion of bladder neck
Neoplasm of prostate primary tumor staging category pT4: Invasion of rectum, levator muscles, and/or pelvic wall
Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy
Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less
Neoplasm of prostate primary tumor staging category T2b: Tumor involves more than one-half of one lobe but not both lobes
Neoplasm of prostate primary tumor staging category T2c: Tumor involves both lobes
Neoplasm of prostate primary tumor staging category TX: Primary tumor cannot be assessed
Neoplasm of prostate regional lymph node staging category N0: No regional lymph node metastasis
Neoplasm of prostate regional lymph node staging category NX: regional lymph nodes not assessed
Neoplasm of prostate regional lymph node staging category pN1: Metastasis in regional node
Neoplasm of vas deferens
Non-metastatic prostate cancer
Obstructive nephropathy due to malignancy
Obstructive nephropathy due to prostate cancer
pM1a: Distant metastasis to non-regional lymph node
pM1b: Distant metastasis to bone
pM1c category
pM1c: Distant metastasis site other than bone or non-regional lymph node
Primary malignant neoplasm of prostate
Prostate cancer metastatic to bone
Prostate cancer metastatic to eye
pT2: Organ confined
pT2a: Unilateral, one-half of one lobe or less
pT2b: Unilateral, involving more than one-half of lobe but not both lobes
pT2c category
pT2c: Bilateral disease
pT3: Extraprostatic extension
pT3a: Extraprostatic extension
pT3b: Seminal vesicle invasion
pT4: Invasion of bladder AND/OR rectum
Recurrent malignant neoplasm of prostate
Secondary malignant neoplasm of rectum
Secondary malignant neoplasm of seminal vesicle
Secondary malignant neoplasm of spermatic cord
Secondary malignant neoplasm of urethra
Secondary malignant neoplasm of vas deferens
Small cell carcinoma of prostate
Squamous cell carcinoma of male genital
Squamous cell carcinoma of prostate
T1: Clinically inapparent prostate tumor not palpable or visible by imaging
T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected
T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected
T1c: Tumor identified by needle biopsy because of elevated PSA: PROSTATE: Biopsy/TURP: PROSTATE: Resection
T2: Tumor confined within the prostate
T2a: Prostate tumor involves one lobe
T3: Prostate tumor extends through the prostatic capsule
T3a: Prostate tumor with extracapsular extension
T3b: Prostate tumor invades the seminal vesicle
Tumor invasion of perineural tissue absent
Tumor invasion of perineural tissue present
Tumor invasion of periprostatic fat absent
Tumor of seminal vesicle
Tumor of seminal vesicle

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to this diagnosis code:

Use Additional Code

code, if applicable, to identify:
hormone sensitivity status Z19.1 Z19.2
rising PSA following treatment for malignant neoplasm of prostate R97.21

Type 1 Excludes

malignant neoplasm of seminal vesicle C63.7

Index to Diseases and Injuries References

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for this diagnosis code are found in the injuries and diseases index:

- Adenocarcinoma - See Also: Neoplasm, malignant, by site;
- - duct
  - - unspecified site
    - - male - C61

- Carcinoma (malignant) - See Also: Neoplasm, by site, malignant;
- - endometrioid
  - - unspecified site
    - - male - C61

- Cystadenocarcinoma - See: Neoplasm, malignant, by site;
- - endometrioid - See: Neoplasm, malignant, by site;
  - - unspecified site
    - - male - C61

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 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 .

Diagnostic Related Groups - MS-DRG Mapping

The is diagnosis code is grouped in the following groups for version MS-DRG V40.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC). applicable from 10/01/2022 through 09/30/2023.

MS-DRG	MS-DRG Title	MCD	Relative Weight
715	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC	12	2.2332
716	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC	12	1.3143

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 to ICD-9 Code

Source ICD-10 Code		Target ICD-9 Code
C61		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.

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.