2024 ICD-10-CM Diagnosis Code Z12.5

Encounter for screening for malignant neoplasm of prostate

ICD-10-CM Code:
Z12.5
ICD-10 Code for:
Encounter for screening for malignant neoplasm of prostate
Is Billable?
Yes - Valid for Submission
Code Navigator:

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)

Z12.5 is a billable diagnosis code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of prostate. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

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

The code is commonly used in family practice medical specialties to specify clinical concepts such as general medical examination.

Clinical Classification

Index to Diseases and Injuries References

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

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 .

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 IndicatorReason 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-CM

  • ICD-9-CM Code: V76.44 - Scrn malig neop-prostate

Patient Education


Prostate Cancer Screening

What is cancer screening?

Cancer is a disease when the cells of the body grow out of control. Cancer screening is having tests to look for signs of cancer before you have any symptoms. By the time cancer causes symptoms, it may have already spread to other parts of your body. A screening test may help find cancer early, when it may be easier to treat.

Cancer screening only tells you whether you might have cancer. It doesn't diagnose cancer. If a screening test shows signs of cancer, you'll need to have other tests to find out if you do have cancer and how serious it may be.

What is prostate cancer screening?

Prostate cancer screening looks for signs of cancer in 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 most common in people over age 50. It usually grows slowly and doesn't cause health problems. In fact, it's possible to live a long life with prostate cancer and never know you have it. But in certain cases, prostate cancer may spread to other parts of the body and can be very serious.

The goal of prostate cancer screening is to find prostate cancers that may be more likely to spread so they can be treated early.

What tests screen for prostate cancer?

Two tests are commonly used to screen for prostate cancer:

  • A prostate-specific antigen test, also called a PSA blood test. PSA is a protein made by your prostate. A high level of PSA in your blood may mean you have prostate cancer, but it's not proof of cancer. That's because many other things may cause high PSA levels, including:

    • Having an enlarged prostate (benign prostatic hyperplasia or BPH)
    • Having other common prostate problems
    • Taking certain medicines

    In general, the higher your PSA, the more likely it is that you have cancer. But a low PSA blood level isn't a guarantee that you don't have cancer.

  • Digital Rectal Examination (DRE). The DRE is a prostate exam. In this exam, your health care provider inserts a lubricated, gloved finger into your rectum to feel your prostate for lumps or anything unusual. A DRE can check only one side of the prostate.

A PSA test or a DRE may be able to detect prostate cancer at an early stage. But it is not clear whether early detection and treatment lower the risk of dying from prostate cancer. You should talk with your provider about the benefits and harms of prostate cancer screening.

What are the possible benefits and harms of prostate cancer screening?

The possible benefits of prostate cancer screening include:

  • Finding and treating prostate cancer early before it spreads
  • Getting a better sense of your prostate cancer risk (based on your PSA test)
  • Peace of mind if your screening shows you're unlikely to have prostate cancer now
  • The option to choose further testing and closely monitor your prostate if your screening shows you may have cancer

The possible harms of prostate cancer screening include:

  • Getting a false positive result. This means that your PSA test shows you may have prostate cancer when you really don't. A false positive may lead to:

    • Worry while you have more tests to look for signs of cancer.
    • A prostate biopsy. In a biopsy, a doctor removes tissue from your prostate so it can be studied under a microscope to look for cancer cells. This is the only way to diagnose cancer. The possible harms of a prostate biopsy include:
      • Fever
      • Pain
      • Blood in semen
      • Urinary tract infection

  • Having prostate cancer treatment that you may not have needed. Prostate cancer screening may lead to a cancer diagnosis, but it's not always clear whether the cancer is likely to grow and spread. You could have unnecessary treatment for cancer that would never have caused any health problems. And the common prostate cancer treatments may have serious, permanent complications, such as:

    • Urinary incontinence
    • Erectile dysfunction
    • Problems controlling your bowel movements (BMs)

Should I be screened for prostate cancer?

Since there are benefits and risks to prostate screening, you should talk with your provider to decide if screening is right for you. You and your provider should consider:

  • Your age. The risk of prostate cancer increases after age 50.
  • Your family health history. If members of your family have had prostate cancer, your risk may be higher.
  • Your race. Prostate cancer is more common in African Americans. They also have a higher risk of developing prostate cancer at a younger age and having more serious disease.
  • Your general health. Are you well enough to have treatment for prostate cancer if it's found?
  • What you prefer. How do you feel about the possible benefits and harms of screening, diagnosis, and treatment?

NIH: National Cancer Institute


[Learn More in MedlinePlus]

Prostate Cancer Screening

Learn about prostate cancer screening, including the potential benefits and harms.
[Learn More in MedlinePlus]

Prostate Cancer Screening (PDQ®)

Learn about prostate cancer screening, including the potential benefits and harms.
[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.