Posted on 17. Apr, 2009 by in Hot Coding Topics
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.
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...
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