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Prostate Cancer Awareness Month (Sept 2026): Documentation and Coding Resources for Your Practice
Act
immediately
Effective date
Not stated in the notice
Identified
Sep 2, 2026
Summary
Healthfirst has released updated documentation and coding guidance for prostate cancer diagnosis coding to improve accuracy and specificity. The resource provides ICD-10-CM code selection rules, documentation requirements, and examples for active treatment, surveillance, and metastatic cases to ensure proper claim submission to Healthfirst.
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What to do
immediately · 4 steps
01Billing and coding teams must review the prostate cancer coding guidance at HFproviders.org/Coding and apply the updated ICD-10-CM coding rules for all Healthfirst claims.
02Providers must ensure documentation includes: clear statement of active treatment status, anatomical location/metastatic sites, related conditions, and disease stage (in situ, localized, regional, distant, unknown, or indolent).
03Coding staff must use C61 for primary malignancy, C79.82 for metastases to prostate, C77-C79 codes for secondary malignancies at other sites, and Z-codes (Z08, Z12.5, Z85.46) for follow-up/surveillance/history as appropriate.
04Update encounter templates and EMR documentation prompts to capture required elements.
If missed: Failure to use correct codes and documentation may result in claim denials or payment adjustments based on Healthfirst's coverage determination policies.
Codes mentioned
C61C79.82C77C78C79Z08Z12.5Z85.46
Original notice
Prostate Cancer Awareness Month (Sept 2026): Documentation and Coding Resources for Your Practice
hfproviders.org · Always check the source before changing claims.