Urology Coding Alert

Question: What is the diagnosis code when G0102 is done?

New Jersey Subscriber

Answer: HCPCS code G0102 (prostate cancer screening; digital rectal examination) is covered only for early detection of prostate cancer. It is not covered for screening for colorectal cancer. To date, none of the Medicare carriers have published diagnosis limitations for this code. The appropriate ICD-9 code would be V76.44 (special screening for malignant neoplasms, other sites, prostate) for the digital rectal exam (DRE) and prostate specific antigen (PSA) screening provided to asymptomatic patients. There is evidence, however, of carriers denying payment when the screening diagnoses are reported. This would appear to be an error in the Medicare claims processing system. At this time, if a denial is received, the practice should contact its Medicare provider education department for clarification and instruction to resubmit the claim.