Prostate Specific Antigen (PSA) Test Coding Tips
Posted on 17. Apr, 2009 by Editor in Hot Coding Topics
Make sure you know when to support your coding with V76.44.
Determining the proper code to report for a PSA test can be a challenge. Your key to proper prostate specific antigen test coding lies in your ability to distinguish a screening PSA test from a diagnostic PSA test. Follow these expert tips to ensure you’re choosing the right codes every time.
Differentiate Screening From Diagnostic
Screening: You should report a screening PSA for a Medicare beneficiary using G0103 (Prostate cancer screening; prostate specific antigen test [PSA]). Some other payers follow these same guidelines.
Don’t miss PQRI for Urology: How to Get the Full Incentive Bonus, with Dr. Michael Ferragamo.
Medicare requires that all yearly screening PSAs be billed with G0103, says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio.
Diagnostic: The correct code for a diagnostic PSA test is 84153 (Prostate specific antigen [PSA]; total), says Teresa A. Dailey, CPC, coding specialist for Urology Center of Spartanburg in South Carolina.
“84153 is a diagnostic code, and would be used when there is an established disease/illness process which is outlined in the LCD [local coverage determinations] for that CPT code,” explains Dan Rogers, administrator for Biloxi Bay Urology Center PLLC and Gulf South Urology in Biloxi, Miss.
“I would bill 84153 when a diagnostic PSA is needed for another medically necessary reason; for example, observation of a rising PSA or a confirmed diagnosis of prostate cancer that requires the PSA be done after treatment has been initiated to assure its effectiveness,” Hollingshead says.
Look for documentation clues: A coder can identify which CPT code to report by looking at the patient’s diagnosis in the medical record, says Laura Cwiklinski, office manager...
If you've already signed in and are still seeing this screen, click here to refresh the page.
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
Loading ...