Oncology & Hematology Coding Alert
Don’t Jump to Conclusions in This Rising PSA Encounter
Question: We have a patient that had prostatectomy, and his prostate-specific antigen (PSA) levels are now rising after radiation. Does this get coded as C61, R97.21, and Z85.46? Is the active prostate treated as an active disease? AAPC Forum Participant Answer: Based on the information you have provided, in this particular scenario you can probably only code R97.21 (Rising PSA following treatment for malignant neoplasm of prostate) with Z85.46 (Personal history of malignant neoplasm of prostate), and Z92.3 (Personal history of irradiation). That’s because the patient’s rising PSA may indicate the prostate cancer is recurring, but it does not suggest a definitive diagnosis of C61 (Malignant neoplasm of prostate). However, you should check your organization’s guidelines regarding the classification of the prostate cancer being active or historic. If the patient only recently underwent the surgery and radiation for the prostate cancer, it is possible your organization may regard it as still active, and coding C61 may be appropriate. Rechecking the guidelines, and querying the provider to clarify, would also be advisable in this case.
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