Another test is the prostate-specific antigen (PSA) blood test. Prostate cancer is the second leading cause of cancer-related death in men and about 62 percent of all diagnosed prostate cancers are found in men age 65 or older.1 Medicare provides coverage of prostate cancer screening tests/procedures for the early detection of prostate cancer. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). The following references for the code Z12.5 are found in the index: The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. Reliance on any information provided by the ICD List website or other visitors to this website is solely at your own risk. Researchers are studying different tests to find those with the fewest risks and most benefits. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals. Diagnosis was not present at time of inpatient admission. Indications and Limitations of Coverage . Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease. 2016 2017 2018 2019 2020 2021 Billable/Specific Code Male Dx POA Exempt. 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. It can also be high if you have an enlarged prostate (BPH) or other prostate problems. There is no standard screening test for prostate cancer. Review other POA exempt codes here . HCPCS Code G0102 for Prostate cancer screening; digital rectal examination as maintained by CMS falls under Screening Examinations and Disease Managem encounter for diagnostic examination-code to sign or symptom, code to identify any family history of malignant neoplasm (, Screening examination for prostate cancer done. If your screening results are abnormal, your doctor may do more tests, such as an ultrasound, MRI, or a biopsy. Non-covered Procedure Codes Sterilization, Encounter for screening for malignant neoplasm of prostate. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. A routine annual screening for all men age 50 and over generally includes a digital rectal exam and PSA blood test. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals. G0102 Prostate cancer screening; digital rectal examination; G0103 Prostate cancer screening; prostate specific antigen test (PSA) ICD10 codes covered if selection criteria are fulfilled: D29.1: Benign neoplasm of prostate; D07.5: Carcinoma in situ; D40.0: Neoplasm of uncertain behavior; N40.0 – N40.3: Enlarged prostate Cancer found early may be easier to treat. The code is valid for the fiscal year 2021 for the submission of HIPAA-covered transactions. The code Z12.5 is applicable to male patients only. 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). A corresponding procedure code must accompany a Z code if a procedure is performed. Encounter for screening for malignant neoplasm of prostate. One test is the digital rectal exam (DRE). Unreported/Not used - Exempt from POA reporting. The contents of the ICD List website are for informational purposes only. Z12.5 is a billable code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of prostate. Section 4103 of the Balanced Budget Act of 1997 provides for coverage of certain prostate cancer screening tests subject to certain coverage, frequency, and payment limitations. General. Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. Covered. If you think you may have a medical emergency, please call your doctor or 911 immediately. The code Z12.5 is applicable to male patients only. Documentation insufficient to determine if the condition was present at the time of inpatient admission. ICD-10-CM Codes › Z00-Z99 Factors influencing health status and contact with health services ; Z00-Z13 Persons encountering health services for examinations ; Encounter for screening for malignant neoplasms Z12 Encounter for screening for malignant neoplasms Z12- Screening exam for prostate cancer; Screening examination for prostate cancer done ICD-10-CM Diagnosis Code Z12.5 Encounter for screening for malignant neoplasm of prostate Z12.5 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. ICD-10-PCS; Female Only Procedure Codes; Male Only Procedure Codes; Analytics . Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories, examinations related to pregnancy and reproduction (. CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Your PSA level may be high if you have prostate cancer. Applicable To Crosswalk; Code Also Crosswalk; Code First Crosswalk; Includes Crosswalk; Note Crosswalk; Type 1 Excludes Crosswalk; Type 2 Excludes Crosswalk; Use Additional Crosswalk; Changes . The 2021 edition of ICD-10-CM Z12.5 became effective on October 1, 2020. It is clinically and virtually impossible to use this code on a non-male patient. The prostate is the gland below a man's bladder that produces fluid for semen. (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. The ICD-10-CM code Z12.5 might also be used to specify conditions or terms like suspected prostate cancer. Cancer screening is looking for cancer before you have any symptoms. Contact Us | Data Files | Privacy | Terms of Service | ICD List 2020. 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. Z12.5 - Encounter for screening for malignant neoplasm of prostate, Factors influencing health status and contact with health services (, Persons encountering health services for examinations (, Encounter for screening for malignant neoplasms (, FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016, FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017, 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, FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021, Finding prostate cancer may not improve your health or help you live longer, Follow-up tests, such as a biopsy, may have complications, Digital rectal exam (Medical Encyclopedia), Prostate cancer screenings (Medical Encyclopedia). Terms like suspected prostate cancer if a Procedure is performed prostate problems specify a medical diagnosis encounter... 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