This screening procedure code requires a diagnosis code of V76.44 that must appear on the claim form. If the patient has symptoms of prostate carcinoma along with the BPH, such as hematuria, nocturia, urinary frequency, and slow stream, a diagnostic PSA can be covered.
Symptoms include:
Specimen Required
Elevated prostate specific antigen [PSA]
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.
Elevated prostate-specific antigen (PSA) levels can be a sign of prostate cancer. It can also indicate noncancerous problems such as prostate enlargement and inflammation.
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.
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.
PSA testing could span ~106 folds, ranging from 0.01 to ~104 ng/mL. In this study, the highest PSA detected was 23,162 ng/mL. The clinical significance of extremely high PSA has not been well defined.
PSA density Theoretically, PSAD could help distinguish between prostate cancer and benign prostatic hyperplasia (BPH) in men whose PSA levels are between 4 and 10 ng/mL.
BPH can raise PSA levels and affect the bladder and urinary tract. Men with BPH may have difficulty urinating. If left untreated, it may also interfere with kidney function.