Urology Coding Alert

Question: Which diagnosis code should we use for prostate specific antigen (PSA) testing for Medicare?

South Carolina Subscriber
 
Answer: It depends, but whatever you do, dont bill the entire battery of PSA tests off one diagnosis.
 
For total PSA (84153, prostate specific antigen [PSA]; total), a long list of diagnosis codes can be used. Check with your local medical review policy (LMRP). For South Carolina, covered diagnosis codes include:

V10.46 malignant neoplasm, prostate
V71.1 observation for suspected neoplasm
170.2  malignant neoplasm, vertebral column, excluding sacrum and coccyx
185 malignant neoplasm, prostate
188.5 malignant neoplasm, bladder neck
196.5 malignant neoplasm, lymph nodes of inguinal region and lower limb
196.6 malignant neoplasm, intrapelvic lymph nodes
599.7 hematuria.
790.93 elevated prostate specific antigen.  
The following states do not allow 600.x (hyperplasia of prostate) to be used for a PSA test: Alabama, Colorado, Connecticut, Florida, Idaho, Kansas, New York, Minnesota, Mississippi, Nebraska, North Carolina, South Carolina, North Dakota, South Dakota, and Wyoming.
 
For a screening PSA on a Medicare patient, use V76.44 (prostate) with G0103 (prostate cancer screening; prostate specific antigen test [PSA], total). When you perform a free PSA (84154, free), use diagnosis code 790.93 (elevated prostate specific antigen [PSA]).
 
Medicare considers complexed testing (84152 complexed [direct measurement]) investigational, and will not pay for it.
  Answers to Reader Questions and You Be the Coder provided by Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding consultancy based in Denver; and Michael Ferragamo, MD, professor of urology at the State University of New York, Stony Brook.