Oncology & Hematology Coding Alert

Don't pass up this PSA ICD-9 list

Medicare is giving prostate screening a nod of approval. A recent decision memo announced CMS- intent to remove V76.44 (Special screening for malignant neoplasms; prostate) from the list of denied codes found in the Laboratory National Coverage Determination (NCD) Manual.

Example: Your oncologist orders a prostate specific antigen test to screen for prostate cancer.

What to do: Report 84153 (Prostate specific antigen [PSA]; total) along with V76.44.

Note: Because removing V76.44 from the denied list would inappropriately result in inclusion on the list of covered blood count diagnoses, CMS also added V76.44 to the list of codes that don't support medical necessity for blood counts.

Read the decision at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=167 and the complete NCD at  www.cms.hhs.gov/coverage/manual7.pdf.

Watch for: Oncologists may also order a PSA test to follow the progress of tumors or to help determine if the prostate cancer is still there after a prostatectomy. According to the April 2005 Medicare National Coverage Determination for lab services, you should be able to be reimbursed when you test for PSA if the oncologist orders the test because the patient has one of the following diagnoses:

- 185--Malignant neoplasm of prostate

- 188.5--Malignant neoplasm of bladder neck

- 196.5-196.8--Secondary malignant neoplasm, lymph nodes

- 198.5--Secondary malignant neoplasm, bone and bone marrow

- 198.82--Secondary malignant neoplasm, genital organs

- 233.4--Carcinoma in situ, prostate

- 236.5--Neoplasm of uncertain behavior of prostate

- 239.5--Neoplasm of unspecified nature, other genitourinary organs

- 596.0--Bladder neck obstruction

- 599.60--Urinary obstruction, unspecified

- 599.7--Hematuria

- 600.01--Benign prostate hypertrophy with urinary obstruction

- 601.9--Unspecified prostatitis

- 602.9--Unspecified disorder of prostate

- 788.20-788.21--Retention of urine

- 788.30--Urinary incontinence, unspecified

- 788.41--Urinary frequency

- 788.43--Nocturia

- 788.62--Slowing of urinary stream

- 788.63--Urgency of urination

- 790.93--Elevated prostate specific antigen

- 793.6-793.7--Nonspecific abnormal result of radiologic examination, evidence of malignancy

- 794.9--Bone scan evidence of malignancy

- V10.46--Personal history of malignant neoplasm; prostate.