Oncology & Hematology Coding Alert

Question: Our center performs its own diagnostic PSA tests for patients diagnosed with BPH based on urinary retention and frequency. What diagnosis code(s) should we use for the test results?

Ohio Subscriber

Answer: If the physician confirms an elevated prostate specific antigen (PSA) result, you should report the diagnosis code that supports those findings -- 790.93 (Elevated prostate specific antigen [PSA]). (Remember to consider the physician's interpretation of the lab results when choosing your code.)

Normal PSA is different: On the other hand, if the physician notes the PSA findings are normal, you should report the reason for the test -- benign prostatic hypertrophy (BPH). Based on the urinary symptoms, the proper code in this case would be 600.01 (Hypertrophy [benign] of prostate with urinary obstruction and other lower urinary tract symptoms [LUTS]). You should report additional codes to identify symptoms, according to ICD-9 instruction. For this case, you would list 788.20 (Retention of urine, unspecified) and 788.41 (Urinary frequency).

Don't forget cancer history: If the patient has a history of prostate cancer, you should additionally report V10.46 (Personal history of malignant neoplasm; prostate). The procedure that Medicare covers for diagnostic PSA testing under the laboratory National Coverage Determination (NCD) is 84153 (Prostate specific antigen [PSA]; total).