Oncology & Hematology Coding Alert

Question: Are G0103 and 84153 interchangeable for PSA (prostate specific antigen) screening lab tests?

Michigan Subscriber Answer: You cannot interchange 84153 (Prostate specific antigen [PSA]; total) and G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). G0103 is a HCPCS Level II code that describes a screening for prostate cancer. You should use this code if your physician performs a screening PSA on Medicare patients who don't exhibit signs or symptoms of the disease.

Medicare will cover a PSA screening annually for men age 50 and older. The screening test is for men who present with no symptoms. You should link G0103 to V76.44 (Special screening for malignant neoplasms; other sites; prostate).

On the other hand, you should report 84153 for a diagnostic PSA lab test when the physician requests the test due to signs, symptoms or diagnoses. For example, when a physician identifies symptoms such as frequent urination, he may order the blood test to determine if the patient has elevated PSA levels. You should link 84153 to the symptoms such as urinary retention (788.20), frequency (788.41), nocturia (788.43) or reduced urine stream (788.62).