Medicare Compliance & Reimbursement

Question: Our laboratory received an order for a PSA test for a patient one year after successful prostate cancer treatment. What diagnosis and procedure codes should we use? Answer: Assuming the ordering physician does not list clinical evidence of recurrent prostate cancer as the reason for the test, you should report the diagnosis as V10.46 (Personal history of malignant neoplasm; genital organs; prostate) and report 84153 (Prostate specific antigen [PSA]; total) for the PSA test. Take care with cancer Dx: Don't list 185 (Malignant neoplasm of prostate) if the ordering physician does not indicate that this is a current cancer patient. Look to V codes for patients whose disease process is no longer active. Mislabeling a patient as an active cancer patient could affect his ability to obtain health or life insurance or affect his treatment by other physicians for other conditions. Look for elevated PSA: If the lab finds [...]