Urology Coding Alert

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.