ICD-10-CM Code R97.20

Elevated prostate specific antigen [PSA]

Version 2020 Billable Code No Valid Principal Dx Adult Diagnoses Diagnoses For Males Only Questionable Admission Codes

Valid for Submission

R97.20 is a billable code used to specify a medical diagnosis of elevated prostate specific antigen [psa]. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code R97.20 might also be used to specify conditions or terms like prostate specific antigen abnormal or raised prostate specific antigen.

The code R97.20 is applicable to adult patients aged 15 through 124 years inclusive. It is clinically and virtually impossible to use this code on a patient outside the stated age range.

According to ICD-10-CM guidelines this code should not to be used as a principal diagnosis code when a related definitive diagnosis has been established.

ICD-10:R97.20
Short Description:Elevated prostate specific antigen [PSA]
Long Description:Elevated prostate specific antigen [PSA]

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code R97.20 are found in the index:


Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

  • Adult diagnoses - Adult. Age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).
  • Diagnoses for males only - Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, this code applies to MALES only .
  • Questionable admission codes - Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code R030 for elevated blood pressure reading, without diagnosis of hypertension, then the patient would have a questionable admission, since elevated blood pressure reading is not normally sufficient justification for admission to a hospital.

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Prostate specific antigen abnormal
  • Raised prostate specific antigen

Diagnostic Related Groups

The ICD-10 code R97.20 is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.

  • 947 - SIGNS AND SYMPTOMS WITH MCC
  • 948 - SIGNS AND SYMPTOMS WITHOUT MCC

Replacement Code

R9720 replaces the following previously assigned ICD-10 code(s):

  • R97.2 - Elevated prostate specific antigen [PSA]

Convert R97.20 to ICD-9

  • 790.93 - Elvtd prstate spcf antgn (Approximate Flag)

Code Classification

  • Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00–R99)
    • Abnormal tumor markers (R97)
      • Abnormal tumor markers (R97)

Code History

  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Prostate Cancer Screening

The prostate is the gland below a man's bladder that produces fluid for semen. Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat.

There is no standard screening test for prostate cancer. Researchers are studying different tests to find those with the fewest risks and most benefits. One test is the digital rectal exam (DRE). The doctor or nurse inserts a lubricated, gloved finger into your rectum to feel the prostate for lumps or anything unusual. Another test is the prostate-specific antigen (PSA) blood test. Your PSA level may be high if you have prostate cancer. It can also be high if you have an enlarged prostate (BPH) or other prostate problems. If your screening results are abnormal, your doctor may do more tests, such as an ultrasound, MRI, or a biopsy.

Prostate cancer screening has risks:

  • Finding prostate cancer may not improve your health or help you live longer
  • The results can sometimes be wrong
  • Follow-up tests, such as a biopsy, may have complications

You and your doctor should discuss your risk for prostate cancer, the pros and cons of the screening tests, and whether you should get them.


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Prostate Diseases

The prostate is a gland in men. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble.

Some common problems are

  • Prostatitis - inflammation, usually caused by bacteria
  • Enlarged prostate (BPH), or benign prostatic hyperplasia - a common problem in older men which may cause dribbling after urination or a need to go often, especially at night
  • Prostate cancer - a common cancer that responds best to treatment when detected early

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


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Prostate Problems The prostate is a small gland in men that helps make semen. Located just below the bladder in front of the rectum, it wraps around the tube that carries urine and semen out of the body.
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