Wiki Diagnosis for PSA labs

[Jessim929]

I was training one of my new providers on coding today, and she mentioned that one of my midlevels told her every time he orders a PSA, he uses a diagnosis like Nocturia or something, not elevated PSA. I'd not heard of such a thing. I mean, it almost makes sense on an initial draw because you don't know if it's elevated or not and there's no such thing as rule out something. I'm kind of thinking its an insurance quirk, but I wanted to know if anyone else has had experience with that.

Thanks!

 

[CBLENNIE]

I think that the provider claiming to always use "Nocturia or something" is a bit concerning as they should be using the diagnosis or symptoms specific to the individual patients for each encounter.

So to clarify when they state "or something" are they meaning that they are using a diagnosis or symptom that is specific to the patient for the encounter and is documented in the medical record as part of encounter note? If the diagnosis is not supported in the medical record or the only place it is used is on the lab order/requisition with nothing to back it up in the patient's medical record I feel like that is a dangerous way of trying to support the medical necessity of the requested PSA test.

I work for an insurance company and if the lab order has a diagnosis that is not mentioned anywhere in the visit note to support it was part of the plan of care or anywhere else in the note for the encounter, we would likely consider it not medically necessary because the medical record doesn't support the diagnosis listed on the lab order/requisition.

However, if the diagnosis on the lab order/requisition is supported in the medical record and the PSA test requested is medically necessary and the standard of care then there shouldn't be an issue in using those diagnoses or symptoms.

 

[Jessim929]

I think that the provider claiming to always use "Nocturia or something" is a bit concerning as they should be using the diagnosis or symptoms specific to the individual patients for each encounter.

So to clarify when they state "or something" are they meaning that they are using a diagnosis or symptom that is specific to the patient for the encounter and is documented in the medical record as part of encounter note? If the diagnosis is not supported in the medical record or the only place it is used is on the lab order/requisition with nothing to back it up in the patient's medical record I feel like that is a dangerous way of trying to support the medical necessity of the requested PSA test.

I work for an insurance company and if the lab order has a diagnosis that is not mentioned anywhere in the visit note to support it was part of the plan of care or anywhere else in the note for the encounter, we would likely consider it not medically necessary because the medical record doesn't support the diagnosis listed on the lab order/requisition.

However, if the diagnosis on the lab order/requisition is supported in the medical record and the PSA test requested is medically necessary and the standard of care then there shouldn't be an issue in using those diagnoses or symptoms.

Oh yeah, he would tailor it to each individual case. Remember, I'm getting this information secondhand. I just wanted to research it a little for my own information. On an initial draw or a patient with PSA WNL it would make sense to pick a symptom or use BPH, but for a PSA that's being tracked, I would be looking at the R97.20 or R97.21