ICD-10 Diagnosis Code R97.20

Elevated prostate specific antigen [PSA]

Diagnosis Code R97.20

ICD-10: R97.20
Short Description: Elevated prostate specific antigen [PSA]
Long Description: Elevated prostate specific antigen [PSA]
This is the 2019 version of the ICD-10-CM diagnosis code R97.20

Valid for Submission
The code R97.20 is valid for submission for HIPAA-covered transactions.

Code Classification
  • Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00–R99)
    • Abnormal tumor markers (R97)
      • Abnormal tumor markers (R97)
Version 2019 Billable Code Adult Diagnoses Diagnoses For Males Only Questionable Admission Codes

Information for Medical Professionals

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.


Code Edits
The following 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 - Diagnoses for 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.

Diagnostic Related Groups
The diagnosis code R97.20 is grouped in the following Diagnostic Related Group(s) (MS-DRG V35.0)

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

Convert to ICD-9
  • 790.93 - Elvtd prstate spcf antgn (Approximate Flag)

Synonyms
  • Prostate specific antigen abnormal
  • Raised prostate specific antigen

Index to Diseases and Injuries
References found for the code R97.20 in the Index to Diseases and Injuries:


Replacement Code
This code replaces the following previously assigned ICD-10 code(s) listed below:
  • R97.2 - Elevated prostate specific antigen [PSA]


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.

  • Digital rectal exam (Medical Encyclopedia)
  • Prostate biopsy (Medical Encyclopedia)
  • Prostate cancer screenings (Medical Encyclopedia)
  • PSA (Medical Encyclopedia)

[Read More]

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

  • Digital rectal exam (Medical Encyclopedia)
  • Prostatitis - acute (Medical Encyclopedia)
  • Prostatitis - nonbacterial (Medical Encyclopedia)
  • Prostatitis-bacterial - self-care (Medical Encyclopedia)
  • Urinary Retention - NIH (National Institute of Diabetes and Digestive and Kidney Diseases)

[Read More]

ICD-10 Footnotes

General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.

Present on Admission
The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement.

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