Pathology/Lab Coding Alert

Question: Are G0103 and CPT 84153 interchangeable for PSA (prostate specific antigen) screening lab tests?

Michigan Subscriber

Answer: You cannot interchange 84153 (Prostate specific antigen [PSA]; total) and G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). G0103 is a HCPCS Level II code that describes a screening for prostate cancer. You should use this code if you perform a screening PSA on Medicare patients who don't exhibit signs or symptoms of the disease.

Medicare will cover a PSA screening annually for men aged 50 and older. The screening test is for men who present with no symptoms. You should link G0103 to V76.44 (Special screening for malignant neoplasms; other sites; prostate).

On the other hand, you should report 84153 for a diagnostic PSA lab test when the physician requests the test due to signs, symptoms or diagnoses. For example, when a physician identifies symptoms such as frequent urination, he may order the blood test to determine if the patient has elevated PSA levels. You should link 84153 to the symptoms such as urinary retention (788.20), frequency (788.41), nocturia (788.43) or reduced urine stream (788.62).

If the physician has already made a diagnosis and orders the PSA to follow treatment, use the specific diagnosis such as 185 (Malignant neoplasm of prostate). When a diagnostic PSA test reveals an elevated antigen level, the diagnosis should reflect the results. CMS' PSA National Coverage Determination instructs coders to report 790.93 (Elevated prostate specific antigen) when the test shows elevated PSA.

The descriptor for 84153 does not specify "screening," so non-Medicare payers may accept 84153 for either a screening or diagnostic PSA. In this case, the diagnosis code linked to 84153 distinguishes the code's use.