Written by Amy Wagner, MEd, CHA, CPC, ICDCT-CM Show Edited by Joanne Byron, BS, LPN, CCA, CHA, CHCO, OHCC, CMDP, ICDCT-CM/PCS More... According to the Cancer Research Institute, prostate cancer is the second most common male cancer in the world. It affects roughly 1.3 million people and kills more than 360,000 people each year, which represents about 4% of all cancer deaths worldwide. In its early stages, prostate cancer is highly treatable, with five-year survival rates close to 100%. Once prostate cancer has metastasized, however, the 5-year survival rate falls to less than 30%, highlighting a significant need for more effective treatment of advanced stage disease. Because prostate cancer is highly curable when detected in the early stages, Medicare (and most commercial payers) cover the cost of annual screening for the disease in male beneficiaries over the age of 50. There are two common tests used to screen for prostate cancer, the digital rectal exam (DRE) and the Prostate specific antigen (PSA) blood test. Medicare requires HCPCS codes to report these tests. G0102 Prostate cancer screening; digital rectal examination
G0103 Prostate cancer screening; prostate specific antigen test (psa)
When ordering a PSA test, there are variables to consider and record which can cause elevated or lower PSA levels. If your practice provides wellness exams and/or orders prostate screening tests, it is highly recommended to modify your patient questionnaire to gather specific information for the ordering provider’s consideration. Factors that might raise PSA levels should be included in the History of Present Illness Documentation, when the test is ordered, such as:
Factors which might lower PSA level – even if the man has prostate cancer:
Outside of the annual screening, if the patient presents with symptoms leading the provider to screen for prostate cancer, code the associated symptoms. 84152 Prostate specific antigen (PSA); complexed (direct measurement) 84153 Prostate specific antigen (PSA); total 84154 Prostate specific
antigen (PSA); free The ICD-10-CM code to use for annual screening services is Z12.5, Encounter for screening for malignant neoplasm of prostate.
Screening may detect nodules or other abnormalities of the prostate. Benign prostatic hyperplasia or hypertrophy, enlarged prostate, or nodular prostate are common conditions code in category N40. The 4th digit is used to describe the condition and/or the presence of associated lower urinary tract symptoms as follows: N40.0 Benign prostatic hyperplasia without lower urinary tract symptoms N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms N40.2
Nodular prostate without lower urinary tract symptoms N40.3 Nodular prostate with lower urinary tract symptoms When coding N40.1 or N40.3, there is a “Use additional code” instruction for associated symptoms as follows: R39.14 Incomplete bladder emptying R35.1 Nocturia R39.16 Straining on urination R35.0 Urinary frequency R39.11 Urinary hesitancy N39.4- Urinary
incontinence N13.8 Urinary obstruction R33.8 Urinary retention R39.15
Urinary urgency R39.12 Weak urinary stream If the biopsy does indicate a cancer diagnosis, code C61 is used. C61 has a “Use additional code” instruction to identify the following:
Referencing the ICD-10-CM Table of Neoplasms, the following codes are also listed with prostate neoplasms:
CPT® Coding: Additional Testing and Treatments for Prostate Cancer An abnormal screening for the prostate may require further testing such as biopsy.
Treatment
When the condition is advanced or is diagnosed as metastatic prostate cancer, chemotherapy is also a treatment option. Radiation treatments are primarily used to treat localized prostate cancer. There are different types of radiation therapy including brachytherapy, radionuclide treatments and external beam radiation therapy (EBRT). The Radiation / Radiation Oncology section of the CPT book will guide the coder to the appropriate treatments in categories in these categories. The following procedures may be appropriate depending on the therapy:
Treatment of prostate cancer may also require surgical removal of the prostate. CPT codes for prostatectomy include:
These codes require careful review of the surgical documentation to determine whether the surgery was partial or total, open or laparoscopic, or included other procedures. Because erectile dysfunction is a common side effect of prostate disease or treatments, a code from category N52 may be appropriate: N52.1 Erectile dysfunction due to disease classified elsewhere Code first underlying disease N52.31 Erectile dysfunction following
radical prostatectomy N52.35 Erectile dysfunction following radiation therapy N52.36 Erectile dysfunction following interstitial seed therapy N52.37 Erectile dysfunction following prostate ablative therapy Once the patient is found to be cancer-free, a code of Z85.46, Personal history of malignant neoplasm of prostate is reported. When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.
Current malignancy versus personal history of malignancy
Subcategories Z85.0 – Z85.7 should only be assigned for the former site of a primary malignancy, not the site of a secondary malignancy. Codes from subcategory Z85.8-, may be assigned for the former site(s) of either a primary or secondary malignancy included in this subcategory. Disclaimer CPT® codes are used as reference only for educational purposes and copyright held by the American Medical Association. The information in this article is not intended as consulting or legal advice. Please consult payer guidelines for coding and coverage information. References
TAGS follow us What is the correct ICDICD-10 code N52. 9 for Male erectile dysfunction, unspecified is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
What is the correct ICDC61: Malignant neoplasm of prostate.
What does e29 1 mean?1 Testicular hypofunction. 5-Alpha-reductase deficiency (with male pseudohermaphroditism) Defective biosynthesis of testicular androgen NOS Testicular hypogonadism NOS.
What is the CPT code for erectile dysfunction?The diagnostic evaluation of Erectile Dysfunction (ED) for males age 21 years and older is reimbursable using CPT codes 54230 and 54250. Prior authorization is required for the diagnostic evaluation of ED.
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