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PSA for history of prostate cancer

  1. Question PSA for history of prostate cancer
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    I've been receiving denials for patients PSAs with Z85.46 (personal history of prostate cancer). Some commercial insurance companies, including BCBS, is considering this as routine services and is patient's responsibility. I don't understand how this is considered routine services and what is the best course to appeal this denial. I cannot change the diagnosis code to C61 because the patients have received treatment, ie; prostatectomy, HDR, and there is no evidence of disease and is not being actively treated for prostate cancer and my physicians are only monitoring the PSA. So my question is how can I fix this??
    Teresa D

  2. Default PSA for Prostate Cancer
    We use Z12.5 for PSA labs.

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