Pathology/Lab Coding Alert

Question: When a physician orders a PSA test for a patient with BPH and the results show elevated PSA, which procedure and diagnosis codes should we report?

Washington Subscriber

Answer: The correct code for a diagnostic prostate specific antigen (PSA) test for a patient with benign prostatic hypertrophy (BPH) is 84153 (Prostate specific antigen [PSA]; total).

Diagnose elevated PSA: Because you specify that the test result shows an elevated PSA, you should report 790.93 (Elevated prostate specific antigen [PSA]) as the diagnosis.

Know obstruction status for BPH: If the test result had been normal, you would report the BPH as the reason for the test. Because you must report the BPH code to the fifth digit, you-ll have to know whether the patient has a urinary obstruction so you can select the proper code as follows:

- 600.00 -- Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS)

- 600.01 -- Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS).

Alternative: If the ordering physician had given the lab a more specific diagnosis, such as prostate cancer, you should report the appropriate code (185, Malignant neoplasm of prostate). Or if the physician only noted signs and symptoms, you should report that condition, such as 788.64 (Urinary hesitancy).

Screening is different: When a physician orders a screening PSA test for a patient with no signs or symptoms of disease, you should use V76.44 (Special screening for malignant neoplasms; other sites; prostate) as the reason for the test.

Know Medicare rule: You should report a screening PSA for a Medicare beneficiary using G0103 (Prostate cancer screening; prostate specific antigen test [PSA]), not 84153.