Urology Coding Alert

Juggling codes for PSA is easy

Knowing how to code for diagnosis and treatment of prostate cancer is a critical skill because more than 1.5 million American men have prostate cancer, according to the National Cancer Institute (NCI).

Typically, urologists use prostate specific antigen tests - 84152 (Prostate specific antigen [PSA]; complexed [direct measurement]), CPT 84153 (... total) and 84154 (... free) - to diagnose prostate cancer.

BPH is often the main diagnosis urologists use when performing screening PSA tests. Many urologists order PSA testing for the diagnoses in the 600 series, such as 600.x (Hyperplasia of prostate), 601.x (Inflammatory diseases of prostate) and 602.x (Other disorders of prostate). But when a urologist uses one of the 600 series of prostate hyperplasia diagnosis codes, the payer may deny the claim.

"BPH, usually, is not covered," says Jodi Stamper, CPC, of Northwest Arkansas Urology Associates. "Most of the time we deal with patients who have prostate cancer or elevated PSAs, and that's usually covered." Link These Diagnoses to Medicare Claims for 84153 In the latter part of 2002, Medicare established a National Coverage Determination policy for ICD-9 diagnoses that would allow payment for diagnostic PSA. The following are approved diagnoses for a "diagnostic" PSA determination (84153). Note: BPH, 600.00, 600.01, etc., are not payable diagnoses.
  185 - Malignant neoplasm of prostate
  188.5 - Malignant neoplasm of bladder neck
  196.5 - Secondary malignant neoplasm; lymph nodes of inguinal region and lower limb
  196.6 - Secondary malignant neoplasm; intrapelvic lymph nodes
  196.8 - Secondary malignant neoplasm; lymph nodes of multiple sites
  198.5 - Secondary malignant neoplasm; bone and bone marrow
  198.82 - Secondary malignant neoplasm; genital organs
  233.4 - Carcinoma in situ; prostate
  236.5 - Neoplasm of uncertain behavior of prostate
  239.5 - Neoplasms of unspecified nature; other genitourinary organs
  596.0 - Bladder neck contracture
  599.6 - Urinary obstruction, unspecified
  599.7 - Hematuria
  601.9 - Unspecified prostatitis
  602.9 - Unspecified disorder of prostate
  788.20 - Retention of urine
  788.21 - Incomplete bladder emptying
  788.30 - Urinary incontinence, unspecified
  788.41 - Urinary frequency
  788.43 - Nocturia
  788.62 - Slowing of urinary stream
  790.93 - Elevated prostate specific antigen
  793.6-793.7 - Nonspecific abnormal finding on radiological examination
  V10.46 - Personal history of malignant neoplasm; prostate.   Use Code V76.44 for Routine Screening For routine screening for prostate cancer - a test done in the absence of [...]