ICD-10 Code R97.21

Rising PSA following treatment for malignant neoplasm of prostate

Version 2019 Billable Code No Valid Principal Dx Adult Diagnoses Diagnoses For Males Only Questionable Admission Codes
ICD-10:R97.21
Short Description:Rising PSA fol treatment for malignant neoplasm of prostate
Long Description:Rising PSA following treatment for malignant neoplasm of prostate

Valid for Submission

ICD-10 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 2019 for the submission of 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)

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 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 - 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 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). The diagnosis code R97.21 is grouped in the following groups for version MS-DRG V36.0 applicable from 10/01/2018 through 09/30/2019.

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

Convert R97.21 to ICD-9

The following crosswalk between ICD-10 to ICD-9 is based based on the General Equivalence Mappings (GEMS) information:

  • 790.93 - Elvtd prstate spcf antgn (Approximate Flag)

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:


Replacement Code

R9721 replaces the following previously assigned ICD-10 code(s):

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

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.