Advanced Search

Urology Coding Alert

Reader Questions:

Choose Diagnosis Based on Documentation, Not Payment

Published on Tue May 11, 2010

Question: Is there a diagnosis code for fluctuating PSA? The patient's PSA is not really elevated, but the urologist is performing a PSA test. The payer will not pay for a screening diagnosis, and I do not see anything else listed in the dictation.Florida SubscriberAnswer: There is no ICD-9 code for a "fluctuating" prostate specific antigen (PSA) level. Ask your urologist why he did the PSA evaluation at this time.Bottom line: If it was a screening PSA, then you have to bill using the screening PSA code and diagnosis -- G0103 (Prostate cancer screening; prostate specific antigen test) and V76.44 (Special screening for malignant neoplasm, prostate).If you feel this may not be paid by insurance, have the patient sign a waiver of liability, and then bill the patient as necessary if payment is denied.Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Urology Coding Alert

View All