Urology Coding Alert
Routine Exams
Texas Subscriber
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
When a comprehensive preventive examination is performed in addition to the prostate screening examination, the preventive medicine code (99387 or 99397), the DRE code and the PSA code may be billed. The patient is responsible for payment of the well-visit exam. Medicare will reimburse the DRE and PSA. It would be highly unusual for a urologist to perform a full examination.
The correct diagnosis code is V76.44 (special screening for malignant neoplasms; prostate).
However, there is evidence of carriers denying payment when the screening diagnoses are reported. This would appear to be an error in the Medicare claims-processing system. If you receive a denial, contact your Medicare provider education department for clarification and instruction.
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