Pathology/Lab Coding Alert

Question: A physician ordered a total PSA test for a 66 year-old patient complaining of reduced urine flow. Should I use the CPT code or the G code to report the test to Medicare?


Arkansas Subscriber

Answer: Because a patient complaint prompted the test, you should report the prostate specific antigen (PSA) test with a CPT code. On your claim, you should:

- Report 84153 (Prostate specific antigen [PSA]; total) for the PSA test.
- Use 788.62 (Slowing of urinary stream) to prove medical necessity for 84153. 
 
You should always strengthen your 84153 claim  by including complete diagnosis coding on the report. The diagnosis does not have to be a known disease or condition; it can simply be signs or symptoms that  the physician suspects might indicate disease. Slowing of the urinary stream is such a symptom, and others might include incomplete bladder emptying (788.21), urinary frequency (788.41) or blood in the urine  (599.7, Hematuria).

G code question: Coders also report some PSA tests with G0103 (Prostate cancer screening; prostate specific antigen test [PSA], total). This code describes a screening for prostate cancer -- meaning that the physician orders the test in the absence of signs or symptoms of disease. Report G0103 only if the lab performs 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.