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C61 ICD-10-CM Code: Malignant neoplasm of prostate

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1 · 3 use-additional codes
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 12 · RxHCC V08 category 22

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 715 — MALE REPRODUCTIVE SYSTEM AND OTHER O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC (MDC 12)
  • MS-DRG 716 — MALE REPRODUCTIVE SYSTEM AND OTHER O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC (MDC 12)
  • MS-DRG 722 — MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC (MDC 12)
  • MS-DRG 723 — MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC (MDC 12)
  • MS-DRG 724 — MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC (MDC 12)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 23 — Prostate, Breast, and Other Cancers and Tumors

Other models: CMS-HCC V22 HCC 12 · RxHCC V08 HCC 22

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for C61 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on C61 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • malignant neoplasm of skin of male genital organs

Source: inherited from C60-C63

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code, if applicable, to identify:
  • hormone sensitivity status (Z19.1-Z19.2)
    Z19.1-Z19.2: Z19.1, Z19.2
  • rising PSA following treatment for malignant neoplasm of prostate (R97.21)

Coder workflow for C61

MedCoder structured workflow — derived from this code’s own official record

Before you code C61

  1. Confirm the documented site and behavior (this code’s block classifies malignant neoplasms), whether the site is primary or secondary, and whether the malignancy is current or a personal history: a previously excised malignancy with no further treatment and no evidence of disease is history, not current disease. Verify the site against the Table of Neoplasms. Neoplasm chapter guidelines (Guidelines I.C.2.a, I.C.2.d, I.C.2.m).

    See the Table of Neoplasms entries · Guide: Active cancer vs history of cancer →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with C61. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in C61’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewC63.7

Consider C61. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Anatomical site
At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Behavior and current-versus-history status
Malignant, in situ, benign or uncertain; primary or secondary; current disease or personal history (Guidelines I.C.2.m).

Official instructions as workflow

  • Excludes1 — check before selecting C61(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with C61: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareC63.7

    See the official tabular notes · Guidelines I.A.12.a

  • Use Additional Code — after identifying C61(3 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with C61 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewR97.21

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition C61 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewC63.7

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with C61?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewR97.21

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse C61 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of C61 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • C63.7— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of malignant neoplasm of seminal vesicle moves the case to C63.7; the two are not reported together unless documented as unrelated.

    Full comparison: C61 vs C63.7 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Malignant neoplasm of prostate is a billable ICD-10-CM diagnosis code (C61).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Neoplasm Table Sites (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Anatomical sites from the official ICD-10-CM Table of Neoplasms that map to this code, with the matching behavior column.

  • Neoplasm, neoplastic, prostate (gland) — Malignant, Primary

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name C61 or its code family, from the CMS ICD-10-CM tabular instructional notes, the CMS Table of Neoplasms and the CMS Table of Neoplasms (site match derived from the code title). Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: N40 — Benign prostatic hyperplasia.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: Z79.81 — Long term (current) use of agents affecting estrogen receptors and estrogen levels.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 5 Same-site neoplasm codes: C79.82 — Secondary malignant neoplasm of genital organsCompare C61 vs C79.82 →, D07.5 — Carcinoma in situ of prostateCompare C61 vs D07.5 →, D29.1 — Benign neoplasm of prostateCompare C61 vs D29.1 →, D40.0 — Neoplasm of uncertain behavior of prostateCompare C61 vs D40.0 →, D49.59 — Neoplasm of unspecified behavior of other genitourinary organCompare C61 vs D49.59 →.

These codes represent related neoplasm behaviors affecting the same anatomic site.

Referenced by 3 Screening & history codes: Z12.5 — Encounter for screening for malignant neoplasm of prostateCompare C61 vs Z12.5 →, Z80.42 — Family history of malignant neoplasm of prostateCompare C61 vs Z80.42 →, Z85.46 — Personal history of malignant neoplasm of prostateCompare C61 vs Z85.46 →.

These codes represent screening tests and history codes that refer to this active disease condition.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 5 MS-DRGs: DRG 715 (MDC 12), DRG 716 (MDC 12), DRG 722 (MDC 12), DRG 723 (MDC 12), DRG 724 (MDC 12).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):NEO039 — Male reproductive system cancers - prostate (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Prostate, Breast, and Other Cancers and Tumors) for risk-adjusted payment.

C54.2 — Malignant neoplasm of myometrium, C54.3 — Malignant neoplasm of fundus uteri, C54.8 — Malignant neoplasm of overlapping sites of corpus uteri, C54.9 — Malignant neoplasm of corpus uteri, unspecified, C55 — Malignant neoplasm of uterus, part unspecified, C60.0 — Malignant neoplasm of prepuce, C60.1 — Malignant neoplasm of glans penis, C60.2 — Malignant neoplasm of body of penis, C60.8 — Malignant neoplasm of overlapping sites of penis, C60.9 — Malignant neoplasm of penis, unspecified, C62.00 — Malignant neoplasm of unspecified undescended testis, C62.01 — Malignant neoplasm of undescended right testis, C62.02 — Malignant neoplasm of undescended left testis, C62.10 — Malignant neoplasm of unspecified descended testis, C62.11 — Malignant neoplasm of descended right testis, C62.12 — Malignant neoplasm of descended left testis, C62.90 — Malignant neoplasm of unspecified testis, unspecified whether descended or undescended, C62.91 — Malignant neoplasm of right testis, unspecified whether descended or undescended, C62.92 — Malignant neoplasm of left testis, unspecified whether descended or undescended, C63.00 — Malignant neoplasm of unspecified epididymis, +213 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic, Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid, Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers, Lung and Other Severe Cancers, Lymphoma and Other Cancers, Bladder, Colorectal, and Other Cancers

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Male reproductive system cancers - prostate).

D07.5 — Carcinoma in situ of prostate

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Carcinoma”, “Adenocarcinoma”; these codes share that main term but sit in a different category of the Tabular List.

C4A.6 — Merkel cell carcinoma of upper limb, including shoulder (Merkel cell, shoulder), C4A.7 — Merkel cell carcinoma of lower limb, including hip (Merkel cell, hip), C4A.8 — Merkel cell carcinoma of overlapping sites (Merkel cell, overlapping sites), C4A.9 — Merkel cell carcinoma, unspecified (Merkel cell), C50.91 — Malignant neoplasm of breast of unspecified site, female (lipid-rich), C50.92 — Malignant neoplasm of breast of unspecified site, male (lipid-rich, male), C53.9 — Malignant neoplasm of cervix uteri, unspecified (solid, microinvasive, unspecified site), C56 — Malignant neoplasm of ovary (granulosa cell), C56.9 — Malignant neoplasm of unspecified ovary (papillocystic, unspecified site), C58 — Malignant neoplasm of placenta (chorionic, unspecified site, female), C62.90 — Malignant neoplasm of unspecified testis, unspecified whether descended or undescended (Sertoli cell, unspecified site), C64 — Malignant neoplasm of kidney, except renal pelvis (renal cell), C73 — Malignant neoplasm of thyroid gland (Hurthle cell), C74.0 — Malignant neoplasm of cortex of adrenal gland (adrenal cortical), C75.0 — Malignant neoplasm of parathyroid gland (water-clear cell), C75.1 — Malignant neoplasm of pituitary gland (basophil, unspecified site), C7A.1 — Malignant poorly differentiated neuroendocrine tumors (neuroendocrine, high grade, any site), C7B.1 — Secondary Merkel cell carcinoma (secondary, Merkel cell), C80.0 — Disseminated malignant neoplasm, unspecified (generalized, with unspecified primary site), C80.1 — Malignant (primary) neoplasm, unspecified (unspecified site), +36 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test, Iron Panel, Prostate-Specific Antigen (PSA)

Contextual Map

Every relationship of C61 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run C61 with these 6 related codes in Claim Check

Hierarchy

Excludes1

Use Additional Code

Same site

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Same-site neoplasm codes

Referenced by Screening & history codes MedCoder-derived

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 23 — Prostate, Breast, and Other Cancers and Tumors [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 12 — Diseases and Disorders of the Male Reproductive System[MDC crossing]: “Diseases and Disorders of the Male Reproductive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,969 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Neoplasm sites

  • Neoplasm, neoplastic, prostate (gland) — Neoplasm, neoplastic, prostate (gland) — Malignant, Primary [Neoplasm table]: “Neoplasm, neoplastic, prostate (gland) (Malignant, Primary)”— CMS Table of Neoplasms · icd10cm-fy2026

Index entries

  • Adenocarcinoma, duct, unspecified site, male[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Carcinoma (malignant), endometrioid, unspecified site, male[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Cystadenocarcinoma, endometrioid, unspecified site, male[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "C61 — Malignant neoplasm of prostate." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/c61-malignant-neoplasm-of-prostate

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Malignant neoplasm of prostate

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.