Primary Care Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: Why isnt there a diagnostic code for a prostate exam as there is for a Pap smear? Is there one for a rectal exam for either a male or female?

Catherine Whitley, San Antonio, Texas

Answer: Medicare is dragging its feet on what it wants to see for new screenings, says Lois Larsen, CPC, physician reimbursement analyst for Bassett Healthcare, a hospital-based 150-member physician group in Cooperstown, N.Y., while most other carriers publish which codes they expect.

Larsen recommends using V76.44 (special screening for malignant neoplasms, prostate) for both a digital rectal exam (DRE) and for a prostate-specific antigen blood test (PSA),which measures PSA, a protein made by prostate cells. If the DRE is for other reasons, perhaps as part of a routine physical for men or a routine pelvic exam for women, she says to use V76.41 (special screening for malignant neoplasms, rectum). Medicare will bundle the rectal exam into the routine pelvic exam, she says, which is V72.3 (gynecological examination, Papanicolaou smear as part of a general gynecological examination and annual or periodic pelvic examination) or V76.2 (special screening for malignant neoplasms, cervix, routine cervical Papanicolaou smear) without the examination.