Urology Coding Alert

Urology practices now can get reimbursed from Medicare for annual prostate cancer screening in men age 50 and older.

Its like mammograms, says Mary Hunter, practice administrator of Pioneer Valley Urology in Springfield, Mass. In other words, prostate cancer screening is so effective that it saves money. The policy, issued in December 1999, allows prostate specific antigen (PSA) testing (84153) once a year as a screening in the absence of any symptoms or diagnoses. Free PSA testing, a derivative of PSA testing, will be allowed only for patients age 70 or younger who previously had a negative prostate biopsy performed because of an elevated PSA, or patients older than 70 years of age who are referred to a urologist for an elevated PSA.

PSA is a tumor marker for adenocarcinoma of the prostate. Although PSA is not a diagnostic test, it can follow the progress of most prostate tumors once diagnosed.

The Medicare decision also covers screening digital rectal examinations once a year to detect prostate cancer. There is no CPT code for this. A rectal exam is included in an office visit. However, there is a HCPCS code for a digital rectal examination (G0102). There is also a HCPCS code for PSA (G0103).

In addition to the cancer diagnosis codes, covered ICD-9 codes for 84153 include urinary tract infection (599.0), various specified and unspecified prostate disorders, urinary frequency (788.41), nocturia (788.43), slowing of urinary stream (788.62) and the screening code V76.44 (special screening for malignant neoplasms prostate).

Note: 84154 (free PSA) is not covered as a screening test. When submitting claims for 84154, be prepared to document an elevated PSA and/or previous negative prostate biopsies.