Tuesday, 8 November 2011

G0103 vs. 84153: Can't Overlook PSA Coding With These Strategies

Inform clients -- their diagnosis coding can lead to success or failure of your claim.

Once your lab receives an order for a prostate specific antigen (PSA) test, you can't just automatically assign one code based on the lab method. Firstly, you are required to decide on the purpose the physician ordered the test, and think through the lab method as well as the payer you're reporting to.

Ensure you're choosing the correct ICD-9 codes and allocating the proper diagnoses by learning these three following expert advices for your PSA claims.

1. Screening vs. Diagnostic

After your lab carries out a PSA assay, your code selection will depend on the reason why the physician ordered the test. Medicare, and some other payers, want that you code screening PSA tests one way and diagnostic tests another.

Screening: For a screening PSA meant for a Medicare beneficiary you'll report G0103 (Prostate cancer screening; prostate specific antigen test [PSA]). Few other payers follow these same guidelines.

Diagnostic: On the contrary, in case the PSA test is meant for diagnostic purposes you'll have following listed three ICD-9 codes to select from:

  • 84152 – i.e Prostate specific antigen (PSA); complexed (direct measurement)

  • 84153 – i.e total

  • 84154 – i.e free.

  • Medicare specifies that 84153 is suitable to distinguish benign and malignant disease in men with symptoms like urinary frequency/urgency or palpably abnormal prostate gland, and to observe the development of prostate cancer following diagnosis and treatment.

    Beware 'complexed' billing: Few physicians desire to evaluate the PSA fraction that is bound to a blood protein (complexed, or cPSA) as the analysis may lead to greater specificity. Studies indicate that cPSA may lead to fewer false positives -- therefore potentially dropping the percentage of healthy patients who go through a confirmatory prostate biopsy.

    2. Diagnosis Should Prove Your Procedure Coding

    You will be able to quickly classify whether to use G0103 or 84153 by studying the ordering physician's documentation. Report G0103 when the physician orders a PSA test for a patient lacking signs or symptoms. In case the physician orders total PSA for a patient as he suspects carcinoma, for instance, owing to clinical findings, you would certainly use 84153.

    Key: Though the PSA screening for an asymptomatic patient leads to a positive finding, still report the screening HCPCS (G0103) and from ICD-9 codes, you must select ICD-9 code (V76.44).

    There are numerous ICD-9 codes that the ordering physician might bring in use for a diagnostic PSA test (84153). Here are a few ICD-9 codes you can pick from, malignant neoplasm of prostate (185), gross hematuria (599.71), or elevated PSA (790.93).

    3. Look out For Frequency Limits

    Medicare covers screening PSA tests once every 12 months for men age 50 years and older. Consequently ensure that at least 11 months have passed since the patient last had a PSA screening.

    The above expert ICD-9 codes insight is brought to you by SuperCoder.com. Click here to read the whole article and have more accurate and profitable expert Medical Coding advice: http://www.supercoder.com/articles/articles-alerts/pac/clinical-lab-g0103-vs.-84153-cant-miss-psa-coding-with-these-3-guidelines-106197/

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