Valid for Submission
R97.21 is a billable code used to specify a medical diagnosis of rising psa following treatment for malignant neoplasm of prostate. The code is valid for the year 2020 for the submission of HIPAA-covered transactions.
The code R97.21 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.
|Short Description:||Rising PSA fol treatment for malignant neoplasm of prostate|
|Long Description:||Rising PSA following treatment for malignant neoplasm of prostate|
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 R97.21 are found in the index:
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.
Diagnostic Related Groups
The ICD-10 code R97.21 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
R9721 replaces the following previously assigned ICD-10 code(s):
- R97.2 - Elevated prostate specific antigen [PSA]
Convert R97.21 to ICD-9
- 790.93 - Elvtd prstate spcf antgn (Approximate Flag)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00–R99)
Abnormal tumor markers (R97)
Abnormal tumor markers (R97)
- 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