Prostate Specific Antigen Test

Ensure that you know when the support of your code V76.44.

Finding the right code report for a prostate specific antigen (PSA) can be a challenge. Your key to correct test of prostate specific antigen coding lies in your ability to distinguish a test of PSA screening from diagnostic PSA test. Here's some expert advice to make sure you are right on target since your PSA coding is concerned.

Aside from the diagnostic testing

Screening: Report a PSA screening for a Medicare beneficiary with G0103 (screening for prostate cancer, prostrate specific antigen test. There are other payers who follow these same guidelines.

Elizabeth Hollingshead, CPC, CMC, billing and coding business manager of Northwest Columbus Urology Inc. in Marysville, Ohio said, Medicare requires that all public service announcements of annual screening is charged G0103.

Diagnosis: According to Teresa A. Dailey, CPC, coding specialist Urology Center of Spartanburg, South Carolina, the correct code for a diagnostic test for PSA is 84 153.

"84,153 is a diagnostic code, and would be used when there is established disease disease process / what is described in the local coverage determinations for the CPT code," said Dan Rogers, director of the Biloxi Bay Urology PLLC Central and southern Gulf of urology at Biloxi, Mississippi

"I bill 84153 when a diagnosis PSA is necessary for another reason medically necessary, for example, observing an increase in PSA or a confirmed diagnosis of prostate cancer requires that the PSA be after treatment was started to ensure its effectiveness, "said Hollingshead.

Be on the lookout for evidence of documentation: a coder can do what a research report code at diagnosis in the patient's medical record, Laura Cwiklinski, office manager at our partners Urology Inc. Cleveland said, but the shares responsibility of doctors. "The medical coder should be able to diagnose patients in doctors' notes. It will allow the coder to know how to use CPT code. It is the responsibility of the doctor to be specific in the development of diagnosis of the patient in the table.

Use Dx to support your choice of code

Where's My Stuff urologist a PSA screening test for a patient with no signs or symptoms of illness, you must use diagnosis code V76.44 (Special screening for malignant tumors of other sites and prostate), the reason test.

Cwiklinski said: "If you code an alternative diagnosis diagnosis with the G0103, Medicare will not pay for it." "You need to use a screening (CPT code) with a screening ICD-9."

Official word: CMS Medicare Preventive Services Guide manual (you can find online (www.cms.hhs.gov / mlnproducts / downloads / psguid. pdf) refers to this requirement:

"There are demands accurate diagnosis of prostrate screening tests and procedures. But if the screening is the reason for the test and / or procedure, the appropriate screening (" V ") diagnosis code must be selected for billing insurance coverage. The diagnosis code screening V76.44 (special screening for malignant tumors, prostrate) is reported. "

New Hope: Roger says: "Some newer LCD screens, you get paid by another diagnosis with the G0103," adding: "I'll always continue to use V76.44 if necessary." But Roger says that decisions news coverage you can code PSA screenings with diagnoses such as benign prostatic hyperplasia (BPH, 600.00 or 600.01) and others.

Check with your payer: Cwiklinski warnings, covered for diagnostic PSA testing vary from payer to payer. Each taxpayer has a list of acceptable diagnosis covered. "You do not have any rejection if the bill within these codes list," she added. Mum.