ICD-10 Codes for Patients Receiving Radiation Therapy for Prostate Cancer
For a patient receiving radiation therapy for prostate cancer, the primary ICD-10 code is C61 (Malignant neoplasm of prostate) along with the appropriate Z51.0 (Encounter for antineoplastic radiation therapy) code. 1
Primary Diagnosis Code
- C61: Malignant neoplasm of prostate
- This is the primary diagnosis code that must be listed first to identify the condition being treated
Radiation Therapy Encounter Code
- Z51.0: Encounter for antineoplastic radiation therapy
- This code should be used as a secondary code to indicate the purpose of the encounter is for radiation therapy
Additional Codes That May Be Required
Depending on the specific clinical scenario, additional codes may be necessary:
- Z85.46: Personal history of malignant neoplasm of prostate (if the patient has completed initial treatment and is receiving adjuvant radiation)
- Z92.3: Personal history of irradiation (if the patient has received radiation therapy in the past)
Coding Based on Stage of Disease
For more specific documentation, consider adding stage-specific codes:
- For localized disease: C61 + Z51.0
- For locally advanced disease: C61 + Z51.0
- For metastatic disease: C61 + appropriate metastasis code (C77.x-C79.x) + Z51.0
Radiation Modality Considerations
The ICD-10 code remains the same regardless of the radiation modality used 1:
- External beam radiation therapy (EBRT)
- Intensity-modulated radiation therapy (IMRT)
- Stereotactic body radiation therapy (SBRT)
- Brachytherapy (HDR or LDR)
Common Coding Pitfalls to Avoid
- Missing the Z51.0 code: Always include this code for radiation therapy encounters
- Using history codes inappropriately: Only use Z85.46 when cancer has been treated and is no longer present
- Failing to code metastases: When present, metastatic sites must be coded separately
- Not updating codes when treatment changes: If a patient moves from active treatment to surveillance, codes should reflect this change
Coding for Treatment Planning vs. Delivery
- For the initial consultation and planning visit: Use C61 as primary
- For actual radiation delivery sessions: Use C61 + Z51.0
Remember that while CPT codes will vary based on the complexity and type of radiation treatment delivered, the ICD-10 diagnosis codes remain consistent throughout the course of radiation therapy for prostate cancer 1.