Urology Coding Alert

Question: How should I code a Medicare patient who has no symptoms and comes in to see a urologist for an exam? I know there is a code for just a digital rectal exam, but should I also use the preventive codes? How should I code an asymptomatic prostate specific antigen (PSA) blood test? Which diagnosis?

Texas Subscriber

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.



Answer: Correct coding depends on the type of routine exam performed. If a prostate cancer screening exam (DRE and PSA) is provided to a Medicare patient 50 years or older, HCPCS codes G0102 (prostate cancer screening; digital rectal examination) and G0103 (prostate cancer screening; prostate specific antigen test) are reported.

When a comprehensive preventive examination is performed in addition to the prostate screening examination, the preventive medicine code (99387 or 99397), the DRE code and the PSA code may be billed. The patient is responsible for payment of the well-visit exam. Medicare will reimburse the DRE and PSA. It would be highly unusual for a urologist to perform a full examination.

The correct diagnosis code is V76.44 (special screening for malignant neoplasms; prostate).

However, there is evidence of carriers denying payment when the screening diagnoses are reported. This would appear to be an error in the Medicare claims-processing system. If you receive a denial, contact your Medicare provider education department for clarification and instruction.