E/M Coding Alert - 2011 Issue 15
Reader Question: 'V' Code Can Help You Support Lab Test Claims
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Article Overview
This reader question and answer article addresses diagnosis and procedure code selection for prostate-specific antigen (PSA) laboratory claims. It compares coding approaches for a post-treatment history of prostate cancer, a lab finding of elevated PSA, and screening PSA testing for Medicare patients. The article is useful for lab billing staff, coders, and compliance teams who need to understand the general documentation and coding distinctions involved in these scenarios.
Why This Topic Matters
Choosing the right diagnosis and procedure coding for PSA-related claims affects claim support, coverage, and how the patient’s record is characterized. The article highlights why different clinical contexts require different coding approaches and why documentation from the ordering provider matters.
Article Sections
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Question
Introduces the laboratory coding scenario and the general type of test involved.
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Answer
Summarizes the coding approach discussed for the post-treatment PSA test scenario.
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Take care with cancer Dx
Discusses broader considerations around coding a current versus historical cancer context for lab claims.
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Look for elevated PSA
Covers the general issue of coding when PSA results are elevated and how that affects supporting diagnoses.
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Screening is different
Explains that screening PSA testing is handled differently from diagnostic testing and may involve payer-specific billing considerations.
What You Will Learn
- How PSA lab testing claims may differ by clinical context
- How historical cancer, elevated findings, and screening are discussed in relation to lab billing
- Why provider documentation matters for supporting the diagnosis on a PSA claim
- How Medicare screening PSA testing is distinguished from other PSA test scenarios
Who Should Read This
- Laboratory billers
- Medical coders
- Compliance staff
- Physician practice coders
- Revenue cycle staff
Codes Discussed
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