Prostate Cancer Screening
According to the Centers for Disease Control and Prevention, Prostate cancer is the most common cancer in American men.
The prostate is a part of the male reproductive system that produces a part of seminal fluid.
Risk factors for prostate cancer include:
? Age
? Family history
? Race
Symptoms of prostate cancer may include:
? Difficulty starting urination
? Weak or interrupted flow of urine
? Frequent urination, especially at night
? Difficulty emptying the bladder completely
? Pain or burning during urination
? Blood in the urine or semen
? Pain in the back, hips, or pelvis that persists
? Painful ejaculation
The American Cancer Society recommends that men of age 50 and older should be screened for prostate cancer whether symptoms persists or not.
There are two tests commonly used to screen for prostate cancer:
? Digital rectal exam (DRE): A qualified healthcare professional inserts a gloved, lubricated finger into the patient?s rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
? Prostate-specific antigen (PSA) test: This is a blood test that measures the level of PSA, a substance made by the prostate. An elevated PSA could be an indication of prostate cancer.
Coding/Billing for Prostate Cancer Screening .
Medicare provides coverage of an annual preventive prostate cancer screening Digital Rectal Exam and Prostate Specific Antigen blood test for all male beneficiaries age 50 and older.
HCPCS Level II code G0102 Prostate cancer screening; digital rectal examination or G0103 Prostate cancer screening; prostate specific antigen test (PSA), total, as appropriate, with ICD-10-CM diagnosis code Z12.5 Encounter for screening for malignant neoplasm of prostate (ICD-9-CM V76.44 Special screening for malignant neoplasms, prostate) can be reported.
Code G0103 is paid under the Clinical Diagnostic Laboratory Fee Schedule and G0102 is paid under the Medicare Physician Fee Schedule for Medicare beneficiaries.
Note: Digital Rectal Examination should not be billed when performed on the same day as an evaluation and management service (CPT(R) codes 99201-99456 and 99499).
CPT is a registered trademark of the American Medical Association.