icd-9-cm diagnosis code for a patient with an elevated prostate specific antigen (psa) test result.

by Demetrius Becker 3 min read

ICD-9 code 790.93 and ICD-10 code R07. 2 indicate an elevated prostate-specific antigen (PSA). A PSA level is considered elevated when determined as elevated by the attending urologist not only by the determined level itself.

What is the ICD-9-CM code for elevated prostate specific antigen (PSA)?

ICD-9-CM Diagnosis Code 790.93 : Elevated prostate specific antigen [PSA] Free, official info about 2015 ICD-9-CM diagnosis code 790.93. Includes coding notes, detailed descriptions, index cross-references and ICD-10-CM conversion info.

Do you code your prostate specific antigen screening correctly?

Get to the correct code with the help of the urologist’s diagnosis. 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.

When to use PSA test code 84153?

If, instead, the urologist orders the test and documents the patient as having, for example, a firm-feeling prostate gland on rectal examination, the PSA test is diagnostic, and you should use 84153.

What is the CPT code for prostate cancer?

If the ordering physician documents a more specific diagnosis, such as prostate cancer, report the appropriate code (for example, C61 Malignant neoplasm of prostate ). Or if the urologist only notes signs and symptoms, codes such as R39.11 Hesitancy of micturition may apply.

What is the ICD-10-CM code for elevated PSA?

ICD-10 code R97. 2 for Elevated prostate specific antigen [PSA] is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .

What ICD-10 code covers PSA test?

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.

What is the ICD code for 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.

What code is R97 20?

Elevated prostate specific antigen20 Elevated prostate specific antigen [PSA]

What does code Z12 11 mean?

Z12. 11: Encounter for screening for malignant neoplasm of the colon.

What does PSA Z12 5 mean?

Z12. 5 - Encounter for screening for malignant neoplasm of prostate | ICD-10-CM.

What is elevated PSA?

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.

What is the difference between G0103 and 84153?

Report G0103 when your urologist orders a PSA test for a patient without signs or symptoms of a problem. But if your urologist performs the test for a patient because he suspects carcinoma, for example, due to clinical findings, you would use 84153.

What is the difference between 84153 and 84154?

PHI should be billed using codes 84153, 84154 and 86316. EPI should be billed using code 0005U....Group 1.CodeDescription84153PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL84154PROSTATE SPECIFIC ANTIGEN (PSA); FREE86316IMMUNOASSAY FOR TUMOR ANTIGEN, OTHER ANTIGEN, QUANTITATIVE (EG, CA 50, 72-4, 549), EACH2 more rows

What is R97 20 elevated PSA?

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.

What is the ICD-10 code for prostatitis?

ICD-10-CM Code for Acute prostatitis N41. 0.

What does the abbreviation PSA stand for medical?

Prostate gland The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in males.

What is the ICd 10 code for prostate cancer?

Elevated prostate specific antigen [PSA] 1 R97.20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2021 edition of ICD-10-CM R97.20 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of R97.20 - other international versions of ICD-10 R97.20 may differ.

Is R97.20 a valid justification for admission to an acute care hospital?

R97.20 is not usually sufficient justification for admission to an acute care hospital when used a principal diagnosis. The following code (s) above R97.20 contain annotation back-references. Annotation Back-References.

What is the code for prostate cancer screening?

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): ...

What is the diagnosis code for malignant neoplasm of prostate?

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.

What is the code for hesitancy of micturition?

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.

What happens if you don't have a PSA?

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.

Do you have to check the PSA code before submitting a claim?

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.

Do you need modifier 25 for PSA?

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.

Can a urologist report PSA 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).