How To Use CPT Code 84153

CPT 84153 refers to the testing of total prostate specific antigen (PSA) levels, which is used to screen for prostate cancer and monitor disease progression. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 84153.

1. What is CPT 84153?

CPT code 84153 is a medical billing code used for the testing of total prostate specific antigen (PSA) levels in patients. This test is typically performed on serum or plasma samples using laboratory analyzers and is used to screen for prostate cancer and monitor disease progression. The code is applicable for various methods of quantitating total PSA, including immunoenzymatic assay and electrochemiluminescence immunoassay (ECLIA).

2. 84153 CPT code description

The official description of CPT code 84153 is: “Prostate specific antigen (PSA); total.”

3. Procedure

1. Patient’s blood is collected, typically in the form of serum or plasma samples.
2. The lab analyst selects an appropriate method for quantitating total PSA, such as immunoenzymatic assay or ECLIA.
3. The chosen method is performed using laboratory analyzers to determine the patient’s total PSA levels.
4. The results are analyzed and reported to the ordering provider for further evaluation and potential diagnosis.

4. Qualifying circumstances

Patients eligible to receive CPT code 84153 services include those experiencing symptoms such as difficult, painful, or frequent urination, and back pain. Additionally, providers may order a total PSA test as a routine health screening for patients at risk of developing prostate cancer. It is important to note that Medicare patients may require the use of G0103 for prostate cancer screening instead of CPT 84153.

5. When to use CPT code 84153

CPT code 84153 should be used when a provider orders a total PSA test for a patient experiencing symptoms indicative of prostate cancer or for routine health screening purposes. This code is also applicable when monitoring patients with slow-growing prostate cancer to check for disease progression.

6. Documentation requirements

To support a claim for CPT 84153, the following information should be documented:

• Patient’s medical history and symptoms indicating the need for a total PSA test.
• Provider’s order for the total PSA test.
• Method used for quantitating total PSA levels (e.g., immunoenzymatic assay or ECLIA).
• Results of the total PSA test and their interpretation by the provider.
• Any follow-up actions or treatment plans based on the test results.

7. Billing guidelines

When billing for CPT code 84153, it is essential to ensure that the patient’s medical record contains the necessary documentation to support the claim. Additionally, be aware that some payers, including Medicare, may require the use of G0103 for prostate cancer screening instead of CPT 84153. Always verify the specific billing requirements and guidelines for each payer to ensure accurate and timely reimbursement.

8. Historical information

CPT 84153 was added to the Current Procedural Terminology system on January 1, 1993. There have been no significant updates to the code since its addition.

9. Similar codes to CPT 84153

Five similar codes to CPT 84153 and how they differ are as follows:

1. CPT 84154: This code is used for the testing of free PSA levels, which can help determine the likelihood of prostate cancer in patients with elevated total PSA levels.
2. CPT 84155: This code is used for the testing of protein levels in serum, plasma, or other body fluids, excluding urine.
3. CPT 84156: This code is used for the testing of protein levels in urine samples.
4. CPT 84157: This code is used for the testing of prealbumin levels, which can help assess a patient’s nutritional status.
5. G0103: This code is used for prostate cancer screening with a PSA test for Medicare patients and may be required by other payers as well.

10. Examples

Here are 10 detailed examples of CPT code 84153 procedures:

1. A 55-year-old male with a family history of prostate cancer undergoes a routine total PSA test as part of his annual physical examination.
2. A 60-year-old male presents with urinary symptoms, including difficulty starting and stopping urination, and is ordered a total PSA test by his provider.
3. A 65-year-old male with a history of benign prostatic hyperplasia (BPH) undergoes a total PSA test to monitor for potential prostate cancer development.
4. A 70-year-old male with slow-growing prostate cancer undergoes a total PSA test to monitor disease progression and determine the need for further treatment.
5. A 50-year-old male with a history of prostatitis undergoes a total PSA test to rule out the possibility of prostate cancer.
6. A 58-year-old male with lower back pain and urinary symptoms undergoes a total PSA test to evaluate the potential presence of prostate cancer.
7. A 62-year-old male with a history of elevated total PSA levels undergoes a follow-up total PSA test to monitor for potential prostate cancer development.
8. A 67-year-old male with a history of prostate cancer undergoes a total PSA test to evaluate the effectiveness of his current treatment plan.
9. A 72-year-old male with urinary symptoms and a family history of prostate cancer undergoes a total PSA test to screen for potential prostate cancer development.
10. A 75-year-old male with a history of prostate cancer and recent changes in urinary symptoms undergoes a total PSA test to evaluate for potential disease recurrence.