Pathology/Lab Coding Alert

Capture additional $27 for diagnostic following screening test. From urinary symptoms to cancer, physicians may order diagnostic PSA tests for lots of reasons. Make sure you understand how ICD-9 codes can help you show medical necessity when your lab bills 84153 (Prostate specific antigen [PSA]; total). Watch for documentation: Regardless of Medicare's "payable diagnoses" listed in the PSA national coverage determination (NCD) or other payer's coverage rules, you need to be sure that you have documentation to support your diagnosis code choice, says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. Distinguish Symptoms and Conditions Although physicians may order a diagnostic PSA with symptom codes such as 788.64 (Urinary hesitancy) or 788.65 (Straining on urination), you're more likely to get an order based on a diagnosis of benign prostatic hypertrophy (BPH), even if the patient presents with other symptoms. Because you must report [...]