Pathology/Lab Coding Alert

Question: Our lab performed repeat PSA tests for a patient who had a radical prostatectomy for prostate cancer four years ago. The PSA level is rising. What procedure and diagnosis codes should I report for each of these encounters?

Maryland Subscriber

Answer: The correct procedure code depends on which test your lab performs. For total PSA, which clinicians typically order following prostate cancer treatment, list 84153 (Prostate specific antigen (PSA); total). For direct measurement of complexed PSA, use 84152 (Prostate specific antigen (PSA); complexed (direct measurement)). Report a free PSA test using 84154 (Prostate specific antigen (PSA); free).

Caution: Because labs can calculate a complexed PSA value from measured values of total and free PSA, some payers will not cover 84152 with 84153 and 84154. Payers may consider 84152 a duplicate test when ordered with 84153 and 84154.

Regarding the diagnosis code, your lab should use the ordering diagnosis provided by the physician requesting the test. For PSA sampling following prostate cancer treatment, the clinician will probably list C61 (Malignant neoplasm of prostate) if the condition is not yet considered personal history.

If you have information regarding the historical PSA testing and see that the levels are rising, the appropriate ICD-10-CM code is R97.21 (Rising PSA following treatment for malignant neoplasm of prostate).