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.
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 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 V37.0 applicable from 10/01/2020 through 09/30/2020.
- 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:
R9721 replaces the following previously assigned ICD-10 code(s):
- R97.2 - Elevated prostate specific antigen [PSA]