You Be the Coder:
PSA G Code: Is It Solely for Patients Without Systems
Published on Wed Feb 02, 2005
Question: My physician saw a Medicare patient with complaints of reduced urination. The physician performed a total prostate specific antigen (PSA) test on the patient, who is 55 years old. Should I report the G code for PSA screening, or the CPT code?
Michigan Subscriber
Answer: Since a patient complaint prompted the test, you should report the PSA test with a CPT code. On your claim, you should:
report 84153 (Prostate specific antigen [PSA];total) for the PSA test.
attach ICD-9 code 788.62 (Slowing of urinary stream) to prove medical necessity for 84153. You should always strengthen your 84153 claim by including complete diagnosis coding on the report. It's a good idea to call the individual payer and see what kinds of diagnoses it accepts for PSA tests.
When you talk to that payer rep, ask her what proves medical necessity for a total PSA test. She's likely to answer with one of these conditions:
185 - Malignant neoplasm of prostate
188.5 - Malignant neoplasm of bladder neck
196.5 - Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb
196.6 - Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
196.8 - Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites
198.5 - Secondary malignant neoplasm of bone and bone marrow
233.4 - Carcinoma in situ of prostate
236.5 - Neoplasm of uncertain behavior of prostate
239.5 - Neoplasms of unspecified nature of other genitourinary organs
596.0 - Bladder neck obstruction
599.6 - Urinary obstruction, unspecified
599.7 - Hematuria
601.9 - Prostatitis, unspecified
602.9 - Unspecified disorder of prostate
788.20 - Retention of urine, unspecified
788.21 - Incomplete bladder emptying
788.30 - Urinary incontinence, unspecified
788.41 - Urinary frequency
788.43 - Nocturia
790.93 - Elevated prostate specific antigen (PSA)
794.9 - Nonspecific abnormal results of other function studies
V10.46 - Personal history of malignant neoplasm of prostate. G code question: Coders also report some PSA tests with G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). However, this code describes a screening for prostate cancer. Report G0103 only if the physician is performing a screening PSA on an asymptomatic Medicare patient. G code regulations: Medicare covers one PSA screening per year for every asymptomatic male patient age 50 years and older. When using G0103, you should connect it to diagnosis V76.44 (Special screening for malignant neoplasms; other sites; prostate) to ensure the claim's success.
