Urology Coding Alert

Question: Is there a diagnosis code for fluctuating PSA? The patient's PSA is not really elevated, but the urologist is performing a PSA test. The payer will not pay for a screening diagnosis, and I do not see anything else listed in the dictation.

Florida Subscriber

Answer: There is no ICD-9 code for a "fluctuating" prostate specific antigen (PSA) level. Ask your urologist why he did the PSA evaluation at this time.

Bottom line: If it was a screening PSA, then you have to bill using the screening PSA code and diagnosis -- G0103 (Prostate cancer screening; prostate specific antigen test) and V76.44 (Special screening for malignant neoplasm, prostate).

If you feel this may not be paid by insurance, have the patient sign a waiver of liability, and then bill the patient as necessary if payment is denied.

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.