Pathology/Lab Coding Alert

Question: What diagnosis codes should we use for screening and diagnostic prostate specific antigen (PSA) tests when ICD-10 goes into effect?

Minnesota Subscriber

Answer: Physicians typically order screening PSA tests using ICD-9 code V76.44 (Special screening for malignant neoplasms; other sites; prostate). Beginning with the Oct. 1 implementation date for ICD-10, physicians should order a screening diagnosis with the direct crosswalk ICD-10 code, Z12.5 (Encounter for screening for malignant neoplasm of prostate).

Diagnostic PSA tests are a different matter. A physician may order a diagnostic PSA test based on many signs or symptoms of disease, or as a follow-up measure for prostate cancer treatment. For that reason, there’s a wide range of ICD-9 codes and ICD-10 crosswalks that you might see on your diagnostic PSA claims.

For instance: The physician might order a PSA test based on one of the following signs and symptoms:

• 600.00 — Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS). The ICD-10 crosswalk for this code is N40.0 (Enlarged prostate without lower urinary tract symptoms).

• 600.01 — Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS). The ICD-10 crosswalk for this code is N40.1 (Enlarged prostate with lower urinary tract symptoms).

• 788.64 — Urinary hesitancy. The ICD-10 crosswalk is R39.11 (Hesitancy of micturition).

• 788.43 — Nocturia. The ICD-10 crosswalk is R35.1 (Nocturia).

Report findings: If the diagnostic PSA test result shows an elevated PSA, you should report 790.93 (Elevated prostate specific antigen [PSA]) as the diagnosis. When ICD-10-CM comes around, you’ll use R97.2 (Elevated prostate specific antigen [PSA]).