Urology Coding Alert

When the mayor of New York City, Rudolph W. Giuliani, who is running against Hillary Clinton for the U.S. Senate, announced April 27 that he has prostate cancer, he urged everyone to get the prostate specific antigen (PSA) test. The publicity can be very beneficial to urologists because it heightens patients awareness. Coders can expect to see many more PSA tests as a result.

The American Urological Association (AUA), which issued a best practice document in February on PSA testing, says it should be up to patients and their physicians to determine whether to have the test. In general, however, the AUA recommends that all men who have 10-year life expectancy (or longer) be offered PSA screening beginning at age 50.

As of this year, Medicare now pays for annual screening for prostate cancer for men age 50 and above. The code for PSA screening is 84153 (prostate specific antigen [PSA]; total). Under Medicares policy, issued in December, this screening can be billed once a year in the absence of any symptoms or diagnoses.

Giuliani did not make his announcement after he got the elevated PSA results. First, he had a biopsy, which is the course AUA recommends. The codes for a prostate biopsy are 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) and 55705 (biopsy, prostate; incisional, any approach). The appropriate diagnosis code is 790.93 (elevated PSA).

There is also free PSA testing, which is a derivative of PSA testing. This test will be allowed only for patients who are age 70 or under who had a negative prostate biopsy subsequent to an elevated PSA in the past, or to patients who are over age 70 and have an elevated PSA. The CPT code for this test is 84154 (prostate specific antigen [PSA]; free) It is not covered by Medicare as a screening test. To be paid, you must document previous negative prostate biopsies and/or an elevated PSA.

PSA testing detects more cancer than digital rectal exams, and it detects it earlier, but it should be used in conjunction with digital rectal exams, according to the AUA. In addition to PSA screening, Medicare allows screening digital rectal examinations on a yearly basis. The rectal exam is included in the office visitthere is no CPT code for it. There are also HCPCS codes for a digital rectal examination (G0102) as well as PSA (G0103).

The HCPCS codes are effective for dates of service of Jan. 1, 2000, and after, explains Sandy Page, CPC,
CCS-P, co-owner of Medical Practice Support Services of Denver. The HCPCS codes are generally reported as part of a yearly physical exam, and if the patient is asymptomatic, says Page. The CPT code is reported when the PSA is done for diagnostic purposes, such as in the case of elevated PSA, urinary obstruction, neoplasms and prostate diseases.

The diagnosis code to be used for cancer screening is V76.44 (special screening for malignant neoplasms, prostate).

Note: For more information on PSA screening, see the article Medicare Now Reimburses PSA Screening on page 13 of the February 2000 issue of Urology Coding Alert.