ICD-10 Coding for Abnormal PSA(R97.20, R97.21)
Complete ICD-10-CM coding and documentation guide for Abnormal PSA. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Abnormal PSA
R97.2Primary Range
Abnormal tumor markers
This range includes codes for abnormal findings of tumor markers, specifically for elevated PSA levels.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R97.20 | Elevated prostate specific antigen [PSA] | Use for elevated PSA levels when there is no confirmed diagnosis of prostate cancer or other specific conditions. |
|
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostate | Use for rising PSA levels in patients with a history of prostate cancer treatment. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for abnormal PSA
Essential facts and insights about Abnormal PSA
Primary ICD-10-CM Codes for abnormal psa
Decision Criteria
clinical Criteria
- PSA level above age-adjusted threshold without symptoms
coding Criteria
- No confirmed diagnosis of prostate cancer or BPH
Applicable To
- Elevated PSA without a history of prostate cancer
Clinical Validation Requirements
- PSA level above 4.0 ng/mL
- Consideration of age-adjusted PSA levels
Code-Specific Risks
- Using R97.20 for PSA screening without symptoms
Coding Notes
- Ensure PSA levels are documented with clinical context, including any medications affecting PSA.
R97.21 - Rising PSA following treatment for malignant neoplasm of prostate
Use for rising PSA levels in patients with a history of prostate cancer treatment.
Applicable To
- Biochemical recurrence of prostate cancer
Excludes
- Active prostate cancer (C61)
Clinical Validation Requirements
- Documented history of prostate cancer treatment
- Rising PSA levels post-treatment
Coding Notes
Ensure documentation includes treatment history and PSA trends.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for screening for malignant neoplasm of prostate
Z12.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Abnormal PSA to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R97.20.
Impact
Clinical: May lead to inappropriate follow-up or treatment., Regulatory: Potential for audit issues., Financial: Risk of claim denials.
Mitigation Strategy
Include specific PSA values, Document clinical context
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with Medicare guidelines., Data Quality: Inaccurate data on screening vs. diagnostic PSA tests.
Mitigation Strategy
Use Z12.5 with G0103 for screening purposes.
Impact
Incorrect coding of PSA tests as diagnostic when they are screening.
Mitigation Strategy
Educate staff on correct code usage and documentation requirements.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Abnormal PSA, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Abnormal PSA
Use these documentation templates to ensure complete and accurate documentation for Abnormal PSA. These templates include all required elements for proper coding and billing.
Elevated PSA in a routine screening
Specialty: UrologyRequired Elements
- PSA level
- Clinical context
- Follow-up plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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