2025 ICD-10-CM code R97.20
(Active) Effective Date: N/A Revision Date: N/A Symptoms, signs, and abnormal clinical and laboratory findings - Abnormal tumor markers Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified Feed
Elevated prostate-specific antigen (PSA) level.
No modifiers are typically associated with this code.
Medical necessity for this code is established when there is a clinical indication for PSA testing, such as routine screening in higher risk individuals, monitoring of prostate cancer patients, or evaluation of urinary symptoms. The level of PSA elevation must be documented, along with the clinical context.
The clinical responsibility for this code involves ordering and interpreting the PSA blood test, counseling the patient regarding the results and the need for further evaluation, and potentially referring the patient to a urologist or oncologist for additional testing and management.
- Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified
- R97.20 is under the broader category of R97.2 (Elevated prostate-specific antigen [PSA]) which falls under R97 (Abnormal tumor markers), and ultimately under R00-R99 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified).
In simple words: This code means a blood test showed a higher than normal level of a protein made by the prostate gland.A high level could mean prostate cancer or other prostate problems, so more tests are usually needed.
This code signifies an elevated prostate-specific antigen (PSA) level detected through laboratory testing.PSA is a protein produced by the prostate gland, and elevated levels can indicate prostate cancer or other prostate conditions.Further investigation is usually required to determine the underlying cause.
Example 1: A 60-year-old male patient presents for a routine physical exam.His PSA level is found to be elevated during routine blood work.This warrants further investigation, such as a repeat PSA test and potentially a prostate biopsy., A 72-year-old male patient with a history of prostate cancer undergoes a follow-up PSA test after radiation therapy.The PSA level is elevated, indicating a possible recurrence of the cancer. This necessitates further imaging and/or treatment., A 55-year-old male patient presents with urinary symptoms. A PSA blood test is ordered, revealing an elevated level.Additional investigations, such as a digital rectal exam and/or prostate biopsy are performed to determine if the elevation is due to benign prostatic hyperplasia (BPH) or prostate cancer.
Documentation should include the patient's age, sex, medical history, presenting symptoms (if any), the PSA test result with units and reference range, date of the test, and any further investigations or consultations performed.The physician's interpretation of the results and the rationale for further management (if any) should be clearly documented.
** This code should not be used as the principal diagnosis for hospital admission unless it represents a complex or unusual situation requiring further investigation and is justified by a significant clinical reason for admission.This code does not indicate a definitive diagnosis, and it is crucial to code any underlying condition once identified.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Urology, Oncology
- Place of Service:Office, Hospital, Clinical Laboratory