ICD-10 Guide

Prostate Cancer With Metastasis

ICD-10 Coding for Prostate Cancer with Metastasis(C61, C79.51)

PRIMARY SPECIALTYOncology

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Prostate Cancer With Metastasis?

Essential facts and insights about Prostate Cancer with Metastasis

Key Clinical Considerations:

Common symptoms include bone pain, weight loss, fatigue, and urinary issues.
Key diagnostic tests include prostate-specific antigen (PSA) levels, biopsy results, and imaging studies (CT, MRI, bone scans).
Physical exam findings may include an enlarged prostate, nodules, or tenderness in the pelvic area.

Clinical Information

Clinical Criteria & Documentation Requirements

Required documentation elements include patient history, clinical findings, diagnostic test results, and treatment plans.
Specific coding terminology includes 'metastatic prostate cancer' and 'advanced stage disease'.
Documentation examples: 'Patient presents with elevated PSA and confirmed metastatic lesions on imaging.'

Coding Guidelines

Usage Guidelines & Examples

Usage guidelines emphasize the importance of specifying metastasis in coding.
Common errors include misclassifying localized prostate cancer as metastatic.

Code Exclusions

Important Exclusions

Excluded conditions include benign prostatic hyperplasia and localized prostate cancer without metastasis.
Alternative codes may include those for other types of cancer or unrelated conditions.

Specialty Focus

Primary Specialty

Oncology

Specialty Applications

Patient populations include older males, particularly those with risk factors such as family history.
Clinical settings include oncology clinics, hospitals, and outpatient treatment centers.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Comprehensive documentation of diagnosis, staging, and treatment is required.

Billing considerations?

Ensure accurate coding to reflect the metastatic nature for appropriate reimbursement.

Prostate Cancer With Metastasis

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

Documentation requirements?

Billing considerations?

Prostate Cancer With Metastasis

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

Documentation requirements?

Billing considerations?