Urology Coding Alert

Question: A patient was diagnosed with prostate cancer in 2012 with a positive prostate biopsy (1 mm adenocarcinoma in 1 of 5 cores on right side, left side negative). The patient opted for watchful waiting and did not want surgery, radiation, etc. Recently this patient had elevation of his PSA to 13.65, up from 10 at the time of his previous biopsy. The urologist performed another prostate biopsy to see if there was progression of the disease. The pathology report came back negative for all cores. Do I still use prostate cancer as a primary diagnosis with elevated PSA as secondary? Will Medicare question the repeat biopsy if the patient already has a diagnosis of prostate cancer?

Pennsylvania Subscriber

Answer: You should still use 185 (Malignant neoplasm of prostate) as a diagnosis for the prostate biopsy. The cancer was not treated and is still present although the recent biopsies apparently missed the tumor. However, the patient still has prostate cancer.

Medicare will not likely question the repeat biopsy as this was performed to evaluate the progression of disease in a patient under watchful waiting. Medicare rarely wishes to be involved with clinical decisions