ICD-10 Coding for Elevated PSA(R97.20, R97.21)
Complete ICD-10-CM coding and documentation guide for Elevated PSA. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Elevated 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 when PSA is elevated without a history of prostate cancer or post-treatment context. |
|
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostate | Use for patients with a history of prostate cancer and rising PSA levels post-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 elevated PSA
Essential facts and insights about Elevated PSA
Primary ICD-10-CM Codes for elevated psa
Decision Criteria
clinical Criteria
- PSA level >4 ng/mL without known cause
documentation Criteria
- Document specific PSA value and rule out transient causes
Applicable To
- PSA level above age-adjusted normal without known cause
Excludes
- R97.21 (Rising PSA following treatment for malignant neoplasm of prostate)
Clinical Validation Requirements
- PSA level >4 ng/mL, adjusted for age
- Exclusion of transient causes such as recent ejaculation or infection
Code-Specific Risks
- Misuse for patients with prostate cancer history
- Incorrect use for screening purposes
Coding Notes
- Ensure documentation specifies PSA levels and excludes transient causes.
R97.21 - Rising PSA following treatment for malignant neoplasm of prostate
Use for patients with a history of prostate cancer and rising PSA levels post-treatment.
Applicable To
- PSA rise post-prostate cancer treatment
Excludes
- R97.20 (Elevated PSA without cancer history)
Clinical Validation Requirements
- PSA doubling time <12 months post-treatment
- Correlation with imaging studies
Coding Notes
Ensure linkage to prostate cancer history is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Elevated 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: Leads to unclear clinical picture., Regulatory: May result in audit flags., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Always document exact PSA values., Include clinical context and history.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data representation of patient conditions.
Mitigation Strategy
Use R97.20 for diagnostic tests when symptoms are present.
Impact
Reimbursement: Potential for incorrect DRG assignment., Compliance: Violation of coding specificity., Data Quality: Misrepresentation of patient cancer history.
Mitigation Strategy
Use R97.21 for rising PSA in patients with prostate cancer history.
Impact
Using screening codes for symptomatic patients.
Mitigation Strategy
Educate providers on proper code selection based on symptoms and history.
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 Elevated PSA, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Elevated PSA
Use these documentation templates to ensure complete and accurate documentation for Elevated PSA. These templates include all required elements for proper coding and billing.
Elevated PSA in Primary Care
Specialty: Primary CareRequired Elements
- PSA level and reference range
- Exclusion of transient causes
- Clinical symptoms and history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Elevated PSA? Ask your questions below.