Prostate specific antigen test payment: Do not mix and match codes
Being denied payment for PSA tests.
Q I am being denied payments for PSA tests. I have been billing 84153 with the diagnosis of V 76.44. What am I doing wrong? Many of my colleagues state that they are being paid for all of their PSAs.
A There are two sets of codes for PSA tests. First are the CPT codes 84152-84154, and the other is a Health Care Procedure Coding System (HCPCS) code specifically for a screening PSA, G0103. There are specific diagnoses that are acceptable to both sets of codes. The screening PSA only can be charged once a year; if charged within less than 12 months of the previous charge, it will be denied by Medicare. The G0103 code is to be used only for the individual in whom you're checking the PSA and who has absolutely no BPH, elevation of their PSA, or any other signs or symptoms of lower tract disease. This code is used strictly when PSA is given as a screening test, and for this, the correct diagnosis is V 76.44.
A As with any consultation, you must consider the basic requirements.
If, in fact, the pediatrician is asking you to provide the services, then the visit should be billed as a subsequent hospital visit and should not be charged as a consult. However, a legitimate request for your advice or opinion regarding treatment of the problem and continued involvement in patient care by the pediatrician will meet the qualifications of a consultation. As an OB/GYN, you will need to be very careful and document clearly, as the likelihood of review is greater.
Potential code for prior authorizations on AMA CPT Editorial Panel meeting agenda
March 28th 2024"Good public and economic policy must align costs, benefits, and incentives; currently, all costs are incurred by physician practices, and all financial savings and benefits from prior authorization accrue to health insurance plans, leading to perverse incentives,” says Alex Shteynshlyuger, MD.
