2025 ICD-10-CM code R97.2
(Active) Effective Date: N/A Revision Date: N/A Symptoms, signs, and abnormal clinical and laboratory findings - Abnormal tumor markers Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Feed
Elevated prostate-specific antigen (PSA).
Modifiers may be applicable depending on the circumstances of the testing and the services provided.Consult your local payer guidelines and coding resources.
Medical necessity for a PSA test is typically established based on the patient's age, risk factors for prostate cancer (e.g., family history, ethnicity), and clinical presentation (e.g., urinary symptoms, abnormal digital rectal exam findings).The test may also be medically necessary for post-treatment monitoring of patients with a history of prostate cancer.Specific medical necessity criteria may vary depending on the payer.
The clinical responsibility for this code lies with the physician who orders and interprets the PSA blood test and subsequently manages the patient's care based on the results. This may involve ordering additional tests or referring the patient to a specialist for further evaluation.
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- R97-R97.8: Abnormal tumor markers
In simple words: This code means a blood test showed a higher than normal level of a protein called PSA, which comes from the prostate gland.A high PSA level could mean something is wrong with the prostate, like cancer or an enlarged prostate, but more tests are needed to find out for sure.
This code signifies an elevated level of prostate-specific antigen (PSA) in a patient's blood.PSA is a protein produced by the prostate gland, and elevated levels can be associated with prostate cancer, benign prostatic hyperplasia (BPH), or other prostate conditions.Further investigation is typically required to determine the underlying cause of the elevated PSA.
Example 1: A 60-year-old male patient presents for a routine physical examination.His PSA level is found to be elevated.The physician orders further tests, including a prostate biopsy, to investigate the possibility of prostate cancer., A 72-year-old male patient with a history of benign prostatic hyperplasia (BPH) presents with urinary symptoms. His PSA level is mildly elevated. The physician attributes the elevated PSA to his BPH and manages his symptoms conservatively., A 55-year-old male patient has undergone treatment for prostate cancer. His PSA level is monitored regularly.A rising PSA level following treatment may indicate recurrence of the cancer, necessitating further evaluation and treatment.
The medical record must include documentation of the PSA test result (including the specific value), the date the test was performed, and the clinical indication for ordering the test (e.g., routine screening, evaluation of urinary symptoms, post-treatment monitoring).Documentation of any additional tests performed (e.g., digital rectal exam, prostate biopsy, imaging studies) and their results should also be included, as well as the physician's assessment and plan of care.
** This code should not be used in isolation.Always consider the overall clinical picture to ensure complete and accurate coding.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a diagnostic code.
- Specialties:Urology, Oncology
- Place of Service:Office, Hospital, Ambulatory Surgical Center, Laboratory