Prostate cancer is one of the most common types of cancer affecting men. While it often stays localized, it can sometimes spread, or metastasize, to other parts of the body. When prostate cancer spreads, it is called secondary prostate cancer.
In healthcare, we use the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding and billing. Accurate ICD-10-CM coding is essential for proper reimbursement and for tracking and analyzing health data.
In this article, we’ll cover ICD-10-CM coding for secondary prostate cancer, as well as the key aspects of this condition, including diagnosis and treatment.
Understanding ICD-10-CM Code C61: Malignant Neoplasm of Prostate
Let’s break down the ICD-10-CM code C61, which is what doctors and medical billers use to classify a malignant neoplasm (cancer) of the prostate.
General Application of Code C61
C61 is a specific, billable code, meaning it’s precise enough to use for insurance claims. This code is, naturally, only for male patients.
The current version, ICD-10-CM C61, went into effect on October 1, 2024, for the 2025 edition.
Nuances in Coding
There are a couple of important conventions to understand when using this code.
First, you might see “Use Additional Code.” This means that you need a second code to fully describe the condition. It ensures that all relevant details are captured.
You might also see “Type 1 Excludes” notes. These specify conditions that cannot be coded together. Understanding these exclusions is super important to avoid coding errors that could lead to claim denials.
Recent Updates
The ICD-10-CM coding system is updated regularly to reflect advances in medical knowledge. Recent updates have introduced new codes related to hormone sensitivity/resistance status. There are also codes now for instances of rising PSA (prostate-specific antigen) levels after treatment, which can be an indicator of cancer recurrence.
Metastatic Prostate Cancer: Definition, Diagnosis, and Staging
Defining Metastatic Prostate Cancer
When prostate cancer spreads from the prostate gland to other parts of the body, it’s known as metastatic prostate cancer. The cancer cells travel through the bloodstream or lymphatic system to colonize distant sites. The most common areas for prostate cancer to metastasize include the lymph nodes and the bones.
You might also hear metastatic prostate cancer referred to as Stage 4 or Stage 4B prostate cancer. These terms all describe the same condition: prostate cancer that has spread beyond the prostate gland.
Diagnostic Tests and Analysis
Diagnosing metastatic prostate cancer involves a combination of tests and analyses. One of the most common is a blood test to measure prostate-specific antigen (PSA) levels. Learn more about PSA tests and what to know. Elevated PSA levels can indicate the presence of prostate cancer, though further testing is needed to confirm metastasis.
Imaging techniques like bone scans and CT scans are used to identify metastases in other parts of the body. These scans can reveal the location and extent of the cancer spread.
A tissue biopsy, where a small sample of tissue is removed and examined under a microscope, is often performed to confirm the presence of cancer cells in the metastatic sites.
The Gleason Score, assigned during biopsy, is another important factor in assessing the aggressiveness of the cancer. This score ranges from 2 to 10, with higher scores indicating a more aggressive form of cancer.
PSA Density
PSA density, which is the PSA level divided by the prostate volume, can also help determine how aggressive the cancer is. This measurement provides a more refined assessment of the cancer’s potential for growth and spread.
Treatment Options and Prognosis for Metastatic Prostate Cancer
When prostate cancer metastasizes, meaning it spreads beyond the prostate gland, treatment becomes more complex. While there’s currently no cure for advanced or metastatic prostate cancer, there are ways to slow the spread, prolong life, and manage symptoms.
Treatment Modalities
Several treatment options are available, and the best approach depends on individual factors, including how far the cancer has spread and the patient’s overall health.
- Hormone therapy (Androgen Deprivation Therapy – ADT): This is a common treatment that aims to lower levels of androgens, hormones that fuel prostate cancer growth.
- Chemotherapy: Chemotherapy drugs can be used to kill cancer cells throughout the body.
- Immunotherapy: This type of treatment helps the body’s immune system recognize and attack cancer cells.
- Precision medicine and clinical trials: Depending on the specific characteristics of the cancer, precision medicine approaches (targeting specific genetic mutations) or participation in clinical trials may be options.
It’s important to distinguish between castration-sensitive and castration-resistant prostate cancer. Castration-sensitive prostate cancer responds to hormone therapy, while castration-resistant prostate cancer continues to grow even when hormone levels are suppressed. Treatment strategies differ depending on whether the cancer is castration-sensitive or resistant.
Prognosis and Survival Rates
The prognosis for metastatic prostate cancer varies. While there’s no cure, treatments can significantly extend life and improve quality of life. According to data from the Surveillance, Epidemiology, and End Results (SEER) Program, the 5-year relative survival rate for metastatic prostate cancer is approximately 31%. This means that, on average, men with metastatic prostate cancer are about 31% as likely to live for 5 years after diagnosis compared to men without prostate cancer.
Symptom Management
Metastatic prostate cancer can cause a range of symptoms, depending on where the cancer has spread. Common symptoms include:
- Bone pain
- Fatigue
- Leg swelling
- Urinary symptoms (painful urination, decreased urine stream, blood in semen)
Managing these symptoms is an important part of treatment. Pain medications, radiation therapy, and other supportive therapies can help improve comfort and quality of life.
Risk Reduction and Prevention
Unfortunately, there aren’t any specific ways to prevent metastatic prostate cancer from developing.
However, there are general guidelines for reducing your overall risk of prostate cancer, including maintaining a healthy diet and weight, avoiding smoking and excessive alcohol, and getting regular check-ups (especially if you have a family history of the disease). Some also consider prostate supplements.
Everyone’s situation is unique, so it’s always best to talk to your doctor about specific steps you can take to manage your risk.
Frequently Asked Questions
What is the ICD-10 code for secondary cancer?
The ICD-10 code for secondary cancer depends on the specific location where the cancer has spread. However, it generally starts with “C79” followed by a code specifying the affected organ or body part. For example, C79.51 is for secondary malignant neoplasm of bone.
What does malignant neoplasm of the prostate mean?
Malignant neoplasm of the prostate simply means that cancer cells have formed in the prostate gland. “Neoplasm” refers to an abnormal growth of tissue, and “malignant” indicates that the growth is cancerous and can spread to other parts of the body.
What is the longest you can live with metastatic prostate cancer?
Survival times with metastatic prostate cancer can vary significantly depending on the individual, the aggressiveness of the cancer, and the effectiveness of treatment. Some men may live for several years, even a decade or more, with advanced treatments, while others may have a shorter survival time.
What are secondary ICD-10 codes?
Secondary ICD-10 codes are used to document additional conditions or complications that a patient has alongside their primary diagnosis. In the context of cancer, a secondary code might be used to specify a comorbidity or a condition caused by the cancer or its treatment, which might also require specific ICD-10 codes.
What happens if you get prostate cancer a second time?
If prostate cancer recurs, it means that cancer cells have returned after a period of remission following initial treatment. The approach to treating recurrent prostate cancer depends on factors like the location of the recurrence, the time since initial treatment, and the patient’s overall health. Treatment options may include radiation, hormone therapy, chemotherapy, or surgery.
Conclusion
Choosing the right ICD-10-CM code for prostate cancer is more than just a billing issue. Accurate coding is essential for:
- appropriate billing
- useful data collection
Metastatic prostate cancer is a serious health issue that requires comprehensive treatment and care. Ongoing research is essential to improve the outlook for people living with this condition.