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Primary Care Coding Alert

Reader Question:

Find Out What Separates G0103 From 84153

Published on Fri Mar 26, 2004

Question: Are 84153 and G0103 interchangeable for PSA (prostate specific antigen) screening labs? The family physicians link V76.44 to both codes.
 
Michigan Subscriber Answer: You cannot interchange 84153 (Prostate specific antigen [PSA]; total) and G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). G0103 describes a screening for prostate cancer. You  should mainly use this code for Medicare patients who receive a screening PSA.

Medicare will cover a PSA screening annually for men age 50 and older. The 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 prostate exam on a Medicare patient and use a nonscreening diagnosis. For example, when an FP identifies an abnormality of the prostate that may indicate a problem, he orders blood tests to determine if the patient has elevated PSA levels. You should link 84153 to the abnormality, such as 600.00-600.91 (Hyperplasia of prostate), 601.0-601.9 (Inflammatory diseases of prostate), 602.8 (Other specified disorders of prostate) or 602.9 (Unspecified disorder of prostate).

The descriptor for 84153 does not specify "screening," so payers other than Medicare may accept 84153 for either a screening or diagnostic PSA. In this case, the diagnosis code linked to 84153 distinguishes the code's use.
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