Medicare AdvantageDocumentationMedium impact
Prostate Cancer Awareness Month (Sept 2026): Documentation and Coding Resources for Your Practice
Healthfirst·Oncology, Urology·Coding
We identified it
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.
Action Required
Immediately: Billing 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. Providers 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). Coding 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. Update encounter templates and EMR documentation prompts to capture required elements. Failure to use correct codes and documentation may result in claim denials or payment adjustments based on Healthfirst's coverage determination policies.