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Urology Coding Alert

Reader Questions:

Link PSA Test to Approved Dx Code

Published on Wed Apr 06, 2005

Question: Which ICD-9 Codes will Medicare allow as showing medical necessity for the PSA test?

Oregon Subscriber

Answer: According to Medicare's latest national coverage determination (NCD), the following ICD-9 codes support medical necessity for the prostate specific antigen (PSA) test, code 84153 (Prostate specific antigen [PSA]; total):
 

  •  185 - Malignant neoplasm of prostate
     
  •  188.5 - Malignant neoplasm of bladder neck
     
  •  196.5-196.8 - Secondary malignant neoplasm, lymph nodes
     
  •  198.5 - Secondary malignant neoplasm, bone and bone marrow
     
  •  198.82 - Secondary malignant neoplasm, genital organs
     
  •  233.4 - Carcinoma in situ, prostate
     
  •  236.5 - Neoplasm of uncertain behavior of prostate
     
  •  239.5 - Neoplasm of unspecified nature, other genitourinary organs
     
  •  596.0 - Bladder neck obstruction
     
  •  599.6 - Urinary obstruction, unspecified
     
  •  599.7 - Hematuria
     
  •  600.01 - Benign prostate hypertrophy with urinary obstruction
     
  •  601.9 - Unspecified prostatitis
     
  •  602.9 - Unspecified disorder of prostate
     
  •  788.20-788.21 - Retention of urine
     
  •  788.30 - Urinary incontinence, unspecified
     
  •  788.41 - Urinary frequency
     
  •  788.43 - Nocturia
     
  •  788.62 - Slowing of urinary stream
     
  •  788.63 - Urgency of urination
     
  •  790.93 - Elevated prostate specific antigen
     
  •  793.6-793.7 - Nonspecific abnormal result of radiologic examination, evidence of malignancy
     
  •  794.9 - Bone scan evidence of malignancy
     
  •  V10.46 - Personal history of malignant neoplasm; prostate.

    For the complete NCD information, go online to     www.cms.hhs.gov/coverage/manual7.pdf.

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