Question:
The lab receives an order for a PSA test for a patient one year after successful prostate cancer treatment. What diagnosis and procedure codes should we use?Texas Subscriber
Answer:
Assuming the ordering physician does not list clinical evidence of recurrent prostate cancer as the reason for the test, you should report the diagnosis as V10.46 (
Personal history of malignant neoplasm; genital organs; prostate) and report 84153 (
Prostate specific antigen [PSA]; total) for the PSA test.
Take care with cancer Dx:
Don't list 185 (
Malignant neoplasm of prostate) if the ordering physician does not indicate that this is a current cancer patient. Look to V codes for patients whose disease process is no longer active. Mislabeling a patient as an active cancer patient could affect his ability to obtain health or life insurance or affect his treatment by other physicians for other conditions.
Look for elevated PSA:
If the lab finds elevated PSA, you should report the diagnosis code that supports those findings -- 790.93 (
Elevated prostate specific antigen [PSA]). You should also report V10.46 as the secondary diagnosis in this case.
Screening is different:
When a physician orders a screening PSA test for a patient in the absence of signs or symptoms of disease, you'll use a different diagnosis code. You'll also use a different procedure code for Medicare and some other payers.
Look to the following diagnosis and procedure codes to get paid for screening PSA for Medicare patients:
- Diagnosis: V76.44 (Special screening for malignant neoplasms; prostate)
- Procedure: G0103 (Prostate cancer screening; prostate specific antigen test [PSA]).