Oncology & Hematology Coding Alert
PSA G Code: Is It Solely for Patients Without Systems
Question: My physician saw a Medicare patient with complaints of reduced urination. The physician performed a total prostate specific antigen (PSA) test on the patient, who is 55 years old. Should I report the G code for PSA screening, or the CPT code? You should always strengthen your 84153 claim by including complete diagnosis coding on the report. It's a good idea to call the individual payer and see what kinds of diagnoses it accepts for PSA tests. G code question: Coders also report some PSA tests with G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). However, this code describes a screening for prostate cancer. Report G0103 only if the physician is performing a screening PSA on an asymptomatic Medicare patient. G code regulations: Medicare covers one PSA screening per year for every asymptomatic male patient age 50 years and older. When using G0103, you should connect it to diagnosis V76.44 (Special screening for malignant neoplasms; other sites; prostate) to ensure the claim's success.
Michigan Subscriber
Answer: Since a patient complaint prompted the test, you should report the PSA test with a CPT code. On your claim, you should:
When you talk to that payer rep, ask her what proves medical necessity for a total PSA test. She's likely to answer with one of these conditions:
Oncology & Hematology Coding Alert
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