2027 ICD-10-CM Diagnosis Code Z12.5Encounter for screening for malignant neoplasm of prostate

ICD-10-CM Codes›Z00–Z99›Z00-Z13›Z12

ICD-10-CM Z12.5
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

Z12.5 is a billable ICD-10-CM diagnosis code for encounter for screening for malignant neoplasm of prostate. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Neoplasm-related encounters.

This medical diagnosis code is frequently used in Family Practice medical specialties to designate conditions such general medical examination.

Code Identity

ICD-10-CM Code
Z12.5
Billable Status
Yes — Valid for Submission
Code Describes
Encounter for screening for malignant neoplasm of prostate
Short Description
Encounter for screening for malignant neoplasm of prostate
Same as the full description in the CMS dataset.
Parent Code
Z12
Encounter for screening for malignant neoplasms

Code Classification

ChapterZ00–Z99Factors influencing health status and contact with health services
SectionZ00-Z13Persons encountering health services for examinations
CategoryZ12Encounter for screening for malignant neoplasms
This CodeZ12.5Encounter for screening for malignant neoplasm of prostate

Present on Admission (POA)Billing

Z12.5 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Persons encountering health services for examinations (Z00-Z13).

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to Z12.5: its own notes plus those printed at Z12, block Z00-Z13, and Chapter 21. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From Z12 Encounter for screening for malignant neoplasms applies to 20 codes
  • encounter for diagnostic examination-code to sign or symptom

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Block Z00-Z13 Persons encountering health services for examinations applies to 156 codes
  • examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Z12 Encounter for screening for malignant neoplasms applies to 20 codes
  • code to identify any family history of malignant neoplasm (Z80.-)

Notes

General instructions on how these codes are used.

From Block Z00-Z13 Persons encountering health services for examinations applies to 156 codes
  • Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.
From Chapter 21 (Z00-Z99) Factors influencing health status and contact with health services applies to 1,425 codes
  • Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
  • (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
  • (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name Z12.5, its category, or a range that includes it.

Excludes2 3

These codes carry an Excludes2 note naming Z12.5: its condition is not part of those codes, and both may be reported when the patient has both.

  • Z13.8 Encounter for screening for other specified diseases and disorders
    screening for malignant neoplasms (Z12.-) names Z12.-, which includes this code
  • Z00 Encounter for general examination without complaint, suspected or reported diagnosis
    special screening examinations (Z11-Z13) names Z11-Z13, which includes this code
  • Z01 Encounter for other special examination without complaint, suspected or reported diagnosis
    screening examinations (Z11-Z13) names Z11-Z13, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR FAC008
Neoplasm-related encounters
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Prostate 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.

The full article covers:

  • What is cancer screening?
  • What is prostate cancer screening?
  • What tests screen for prostate cancer?
  • What are the possible benefits and harms of prostate cancer screening?
  • Should I be screened for prostate cancer?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert Z12.5 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
V76.44 Scrn malig neop-prostate
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About Z12.5Overview

What is the ICD-10 code for encounter for screening for malignant neoplasm of prostate?

The ICD-10-CM code for encounter for screening for malignant neoplasm of prostate is Z12.5 (sometimes written as Z125). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is Z12.5 (Encounter for screening for malignant neoplasms) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report encounter for screening for malignant neoplasm of prostate on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does Z12.5 group to?

When encounter for screening for malignant neoplasm of prostate is the principal diagnosis on an inpatient stay, it groups to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.

Is Z12.5 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for encounter for screening for malignant neoplasm of prostate on inpatient claims. The code appears in the Persons encountering health services for examinations (Z00-Z13) range of the CMS exempt list.

Does Z12.5 need an additional code?

When the condition applies, yes. The Use Additional Code note at Z12, which applies to Z12.5, reads: code to identify any family history of malignant neoplasm (Z80.-). The additional code is reported after Z12.5.