Pathology/Lab Coding Alert
You Can't Double-Dip for Measured and Calculated Values
Question: A physician ordered free, total, and complexed PSA on the same date. We received a denial for the complexed PSA test, and would like to know why we cannot report those codes together. Answer: Physicians may order prostate specific antigen (PSA) tests for many reasons, and coverage rules vary depending on the patient's diagnosis and the payer. The PSA test codes are: For a screening PSA test ordered in the absence of signs or symptoms of disease, Medicare will only accept G0103 ordered with ICD-9 code V76.44 (Special screening for malignant neoplasms; prostate). You should use the CPT codes for diagnostic PSA tests.
Missouri Subscriber
Physicians may order one or more of the tests 84152-84154 to diagnose symptomatic patients or to monitor prostate cancer treatments. Medicare's PSA National Coverage Determination describes coverage for 84153, and some local carriers further distinguish coverage for 84152 and 84154. For example, some carriers will not reimburse total (84153) and free (84154) PSA tests on the same day.
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.
- Reader Questions were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.
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You Can't Double-Dip for Measured and Calculated Values
Question: A physician ordered free, total, and complexed PSA on the same date. We received [...]
