Rising PSA following treatment for malignant neoplasm of prostate. 2017 - New Code 2018 2019 Billable/Specific Code Adult Dx (15-124 years) Male Dx Questionable As Admission Dx. R97.21 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
When the urologist orders a diagnostic PSA test and the documentation specifies that the test result shows an elevated PSA, report diagnosis R97.20 Elevated prostate specific antigen [PSA]. If the test results are normal, however, one of the following benign prostatic hyperplasia (BPH) codes may be appropriate:
Rising PSA following treatment for malignant neoplasm of prostate. The 2019 edition of ICD-10-CM R97.21 became effective on October 1, 2018. This is the American ICD-10-CM version of R97.21 - other international versions of ICD-10 R97.21 may differ.
R97.2 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail. The 2022 edition of ICD-10-CM R97.2 became effective on October 1, 2021.
Report HCPCS Level II code G0102 Prostate cancer screening; digital rectal examination or G0103 Prostate cancer screening; prostate specific antigen test (PSA), total, as appropriate, with ICD-10-CM diagnosis code Z12. 5 Encounter for screening for malignant neoplasm of prostate (ICD-9-CM V76.
. Medicare coverage for screening PSAs is limited to once every 12 months Diagnostic PSAs CPT codes for diagnostic PSA tests are 84153: EPIC: LAB4427 TIP: Free and Total PSA is a diagnostic PSA and should be coded as such.
20 Elevated prostate specific antigen [PSA]
Elevated prostate specific antigen [PSA] The 2022 edition of ICD-10-CM R97. 2 became effective on October 1, 2021. This is the American ICD-10-CM version of R97.
Elevated prostate specific antigen [PSA] R97. 20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM R97. 20 became effective on October 1, 2021.
The PSA velocity isn't a separate test. Instead, it's a measure of the change in your PSA levels over time. Even when the total PSA value isn't higher than 4, a high PSA velocity (a rise of more than 0.75 ng/mL in 1 year) means you might have cancer and should consider a biopsy.
For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can ejaculation or vigorous exercise (such as cycling) in the 2 days before testing.
Some payers, including Medicare, have different coding requirements for screening and diagnostic PSA tests. For a Medicare patient, report a screening PSA with G0103 Prostate cancer screening; prostate specific antigen test (PSA) and a diagnostic PSA with one of the following three codes (based on the type of test): ...
For a screening test for a patient with no signs or symptoms of disease, use diagnosis code Z12.5 Encounter for screening for malignant neoplasm of prostate. If you report another diagnosis code with G0103, Medicare will not pay for it. You must use a screening diagnosis with a screening CPT® code.
Or if the urologist only notes signs and symptoms, codes such as R39.11 Hesitancy of micturition may apply. Medicare will consider many diagnosis codes indicating urological signs or symptoms as payable for PSA determinations, such as: This, of course, is a short list.
Prostate specific antigen (PSA) screenings are commonplace in most urology practices, which means if you don’t have your procedure and diagnosis coding straight, you may face high denial rates and possibly significant revenue loss. Avoid those pitfalls with these three tips.
Once you decide on the codes , there’s one more point to check before submitting the claim: Payers have tight restrictions on the frequency for which they will pay for PSA tests.
You should not need modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service on the E/M service, as a global period does not apply to the PSA laboratory test.
If the urologist performs a separate evaluation and management (E/M) service during the same encounter as the PSA test, you should be able to separately report the PSA test code and the appropriate E/M code (based on the documented level of service).