ICD-10-CM Code Z12.5

Encounter for screening for malignant neoplasm of prostate

Version 2020 Billable Code Diagnoses For Males Only POA Exempt

Valid for Submission

Z12.5 is a billable code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of prostate. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z12.5 might also be used to specify conditions or terms like suspected prostate cancer. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z12.5 is applicable to male patients only. It is clinically and virtually impossible to use this code on a non-male patient.

ICD-10:Z12.5
Short Description:Encounter for screening for malignant neoplasm of prostate
Long Description:Encounter for screening for malignant neoplasm of prostate

Index to Diseases and Injuries

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 the code Z12.5 are found in the index:


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 - Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, this code applies to MALES only .

Synonyms

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

  • Suspected prostate cancer

Present on Admission (POA)

Z12.5 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z12.5 to ICD-9

  • V76.44 - Scrn malig neop-prostate

Code Classification

  • Factors influencing health status and contact with health services (Z00–Z99)
    • Persons encountering health services for examinations (Z00-Z13)
      • Encounter for screening for malignant neoplasms (Z12)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Prostate Cancer Screening

The prostate is the gland below a man's bladder that produces fluid for semen. Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat.

There is no standard screening test for prostate cancer. Researchers are studying different tests to find those with the fewest risks and most benefits. One test is the digital rectal exam (DRE). The doctor or nurse inserts a lubricated, gloved finger into your rectum to feel the prostate for lumps or anything unusual. Another test is the prostate-specific antigen (PSA) blood test. Your PSA level may be high if you have prostate cancer. It can also be high if you have an enlarged prostate (BPH) or other prostate problems. If your screening results are abnormal, your doctor may do more tests, such as an ultrasound, MRI, or a biopsy.

Prostate cancer screening has risks:

  • Finding prostate cancer may not improve your health or help you live longer
  • The results can sometimes be wrong
  • Follow-up tests, such as a biopsy, may have complications

You and your doctor should discuss your risk for prostate cancer, the pros and cons of the screening tests, and whether you should get them.


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