Every 17 minutes another man dies from prostate cancer in the United States.
September
is National Prostate Cancer Awareness Month and a great time to help raise
awareness about this disease. Prostate cancer is the most common cancer and the
second leading cause of cancer death among American men. In 2019, nearly
175,000 men will receive a diagnosis of prostate cancer, with an estimated
32,000 deaths from this disease by year’s end. Early detection is key to living
prostate cancer-free; help spread the word and know how to code/bill for prostate
cancer screening services.
Prostate Cancer Basics
Prostate
cancer is a disease in which malignant (cancer) cells form in the tissues of
the prostate, a walnut-shaped gland that sits at the base of the bladder.
Currently, there are nearly 3.1 million American men living with the disease
and one in nine American men will have prostate cancer during his
lifetime. Despite the startling number of men stricken with this disease,
most men with prostate cancer survive it.
Increased
age, race, and family history of the disease are the major risk factors. The
chance of developing the disease dramatically increases at age 55 and is
predominant in men over 65. For unknown reasons, the risk of prostate cancer is
about 60% higher in African American men than in Caucasian American
men. Prostate cancer usually grows very slowly, and early prostate cancer
often causes no symptoms. By the time symptoms appear, cancer may have
begun to spread. The goal of screening for prostate cancer is to find cancer
early and treat it before it metastasizes.
The
American Cancer Society recommends all men talk with their healthcare provider,
so they can decide if prostate cancer screening is right for them. Men
should have this talk at:
- Age 50: if they are at average risk
for prostate cancer and are expected to live at least another 10 years.
- Age 45: if they are at high risk
because they are African American or have a close relative (father,
brother, or son) who had prostate cancer before age 65.
- Age 40: if they are at even higher
risk of getting prostate cancer because more than one close relative had
prostate cancer before age 65.
Screening
for Prostate Cancer
- Digital rectal exam (DRE) is an exam of the rectum. A
healthcare provider inserts a gloved, lubricated finger into the lower
part of the rectum to feel the prostate for abnormalities such as cancer.
- Prostate-Specific Antigen (PSA) test is a test that measures the
level of PSA in the blood. PSA is a substance made primarily by the
prostate that may be found in an increased amount in the blood of men who
have prostate cancer. Other conditions that affect the prostate, such as
enlargement and infection and certain medications and medical procedures,
also elevate PSA levels.
If
the PSA test is higher than normal, the doctor may order a biopsy of the
prostate to assist in diagnosis.
Coding/Billing
Prostate Cancer Screening
Because
the risk for prostate cancer increases with age, Medicare covers annual
prostate cancer screening for all male beneficiaries 50 years and older. At
least 11 months must have passed following the month in which the last
Medicare-covered screening DRE or PSA test was performed.
For
Medicare patients, report the following HCPCS Level II codes, as appropriate:
- G0102 Prostate cancer screening; digital rectal examination
- G0103 Prostate cancer screening; prostate-specific antigen test
(PSA)
The
ICD-10 diagnosis code to support either screening is Z12.5 Encounter for screening for
malignant neoplasm of prostate.
There
is no deductible or coinsurance/co-payment for the PSA test, but there is for
the screening DRE under Medicare Part B.
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