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LCD for Prostate Specific Antigen PSA

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LCD for Prostate Specific Antigen PSA Powered By Docstoc
					  LCD for Prostate Specific Antigen (PSA)
Applicable CPT Code(s):

84152 – Prostate Specific Antigen (PSA); Complexed (Direct
Measurement)
84153 – Prostate Specific Antigen (PSA); Total
84154 – Prostate Specific Antigen (PSA); Free
G0103 – Prostate Cancer Screening; Prostate Specific Antigen Test
(PSA)

ICD-9 Codes that Support Medical Necessity:

Code      Description
600.21    BENIGN LOCALIZED HYPERPLASIA OF PROSTATE WITH
          URINARY OBSTRUCTION AND OTHER LOWER URINARY
          TRACT SYMPTOMS (LUTS)
596.0     BLADDER NECK OBSTRUCTION
233.4     CARCINOMA IN SITU OF PROSTATE
790.93    ELEVATED PROSTATE SPECIFIC ANTIGEN [PSA]
599.71    GROSS HEMATURIA
599.70    HEMATURIA, UNSPECIFIED
600.01    HYPERTROPHY (BENIGN) OF PROSTATE WITH URINARY
          OBSTRUCTION AND OTHER LOWER URINARY TRACT
          SYMPTOMS (LUTS)
600.00    HYPERTROPHY (BENIGN) OF PROSTATE WITHOUT
          URINARY OBSTRUCTION AND OTHER LOWER URINARY
          TRACT (LUTS)
788.21    INCOMPLETE BLADDER EMPTYING
188.5     MALIGNANT NEOPLASM OF BLADDER NECK
185       MALIGNANT NEOPLASM OF PROSTATE
599.72    MICROSCOPIC HEMATURIA
236.5     NEOPLASM OF UNCERTAIN BEHAVIOR OF PROSTATE
239.5     NEOPLASM OF UNSPECIFIED NATURE OF OTHER
          GENITOURINARY ORGANS
788.43    NOCTURIA
600.11    NODULAR PROSTATE WITH URINARY OBSTRUCTION
600.10    NODULAR PROSTATE WITHOUT URINARY OBSTRUCTION
793.6     NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL
          AND OTHER EXAMINATION OF ABDOMINAL AREA,
          INCLUDING RETROPERITONEUM
V10.46  PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
        PROSTATE
601.9   PROSTATITIS UNSPECIFIED
788.20  RETENTION OF URINE UNSPECIFIED
V76.44* SCREENING FOR MALIGNANT NEOPLASMS OF THE
        PROSTATE
196.6   SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM
        OF INTRAPELVIC LYMPH NODES
196.5   SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM
        OF LYMPH NODES OF INGUINAL REGION AND LOWER
        LIMB
196.8   SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM
        OF LYMPH NODES OF MULTIPLE SITES
198.5   SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE
        MARROW
198.82  SECONDARY MALIGNANT NEOPLASM OF GENITAL ORGANS

788.62    SLOWING OF URINARY STREAM
788.65    STRAINING ON URINATION
602.9     UNSPECIFIED DISORDER OF PROSTATE
788.63    URGENCY OF URINATION
788.41    URINARY FREQUENCY
788.64    URINARY HESITANCY
788.30    URINARY INCONTINENCE UNSPECIFIED
599.69    URINARY OBSTRUCTION, NOT ELSEWHERE CLASSIFIED
599.60    URINARY OBSTRUCTION, UNSPECIFIED

*ICD-9-CM code V76.44 should only be reported with HCPCS code
G0103 for a screening PSA test. It may not be used with other PSA
tests (84152, 84153, or 84154).
  NCD for Prostate Specific Antigen (PSA)
Applicable CPT Code(s):

84153 – Prostate Specific Antigen (PSA), total

ICD-9 Codes that Support Medical Necessity:

Code                Description
600.21              Benign localized hyperplasia of prostate with
                    urinary obstruction and other lower urinary tract
                    symptoms (LUTS)
600.21              Benign localized hyperplasia of prostate with
                    urinary obstruction and other lower urinary tract
                    symptoms (LUTS)
596.0               Bladder neck obstruction
794.9               Bone scan evidence of malignancy
794.9               Bone scan evidence of malignancy
233.4               Carcinoma in situ, prostate
790.93              Elevated prostate specific antigen (PSA)
790.93              Elevated prostate specific antigen (PSA)
599.71              Gross hematuria
599.71              Gross hematuria
599.70              Hematuria, unspecified
600.01              Hypertrophy (benign) of prostate with urinary
                    obstruction and other lower urinary tract
                    symptoms (LUTS)
600.01              Hypertrophy (benign) of prostate with urinary
                    obstruction and other lower urinary tract
                    symptoms (LUTS)
600.00              Hypertrophy (benign) of prostate without urinary
                    obstruction and other lower urinary tract (LUTS)
600.00              Hypertrophy (benign) of prostate without urinary
                    obstruction and other lower urinary tract (LUTS)
788.21              Incomplete bladder emptying
788.21              Incomplete bladder emptying
188.5               Malignant neoplasm of bladder neck
185                 Malignant neoplasm of prostate
599.72              Microscopic hematuria
599.72              Microscopic hematuria
236.5               Neoplasm of uncertain behavior of prostate
239.5               Neoplasm of unspecified nature, other
         genitourinary organs
788.43   Nocturia
788.43   Nocturia
600.11   Nodular prostate with urinary obstruction
600.11   Nodular prostate with urinary obstruction
600.10   Nodular prostate without urinary obstruction
600.10   Nodular prostate without urinary obstruction
793.6    Non-specific (abnormal) findings on radiological
         and other examination of abdominal area,
         including retroperitoneum
793.7    Non-specific (abnormal) findings on radiological
         and other examination of musculoskeletal system
793.6    Non-specific (abnormal) findings on radiological
         and other examination of abdominal area,
         including retroperitoneum
793.7    Non-specific (abnormal) findings on radiological
         and other examination of musculoskeletal system
V10.46   Personal history of malignant neoplasm; prostate
V10.46   Personal history of malignant neoplasm; prostate
788.20   Retention of urine, unspecified
788.20   Retention of urine, unspecified
198.5    Secondary malignant neoplasm, bone and bone
         marrow
198.82   Secondary malignant neoplasm, genital organs
196.6    Secondary malignant neoplasm, intrapelvic lymph
         nodes
196.5    Secondary malignant neoplasm, lymph nodes of
         inguinal region & lower limb
196.8    Secondary malignant neoplasm, lymph nodes of
         multiple sites
788.62   Slowing of urinary stream
788.62   Slowing of urinary stream
788.65   Straining on urination
788.65   Straining on urination
602.9    Unspecified disorder of prostate
602.9    Unspecified disorder of prostate
601.9    Unspecified prostatitis
601.9    Unspecified prostatitis
788.63   Urgency of urination
788.63   Urgency of urination
788.41   Urinary frequency
788.41   Urinary frequency
788.64   Urinary hesitancy
788.64           Urinary   hesitancy
788.30           Urinary   incontinence, unspecified
788.30           Urinary   incontinence, unspecified
599.60, 599.69   Urinary   obstruction

				
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posted:5/24/2011
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