Coding Analysis for Labs (CAL) Tracking Sheet

Prostate Specific Antigen (Inclusion of ICD-9-CM Code 600.01 for BPH with Urine Obstruction)

CAG-00232N

Issue

The current national coverage determination (NCD) for Prostate Specific Antigen includes in the list of “ICD-9-CM Codes Covered by Medicare” code 599.6 for urinary obstruction. Effective October 1, 2003, ICD-9-CM added a new code, 600.01, for benign prostatic hypertrophy (BPH) with urinary obstruction. It is no longer appropriate coding to code urinary obstruction separately on a beneficiary with BPH. We have been requested to add code 600.01 to the list of codes covered by Medicare for prostate specific antigen tests. We will be reviewing this code more carefully with the benefit of public comment to make a determination.

National Coverage Determinations

Benefit Category

Diagnostic Laboratory Tests

Requestor Information

Requestor Name Requestor Letter
Marcie Yoh, Good Samaritan Hospital, Baltimore, Maryland N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
03/18/2004
Expected CAL Completion Date
06/17/2004
Public Comment Period
03/19/2004 - 04/19/2004
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
06/18/2004

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers

Medicare Benefit Category Determination Date

Actions Taken

March 19, 2004

Opened formal NCD request and posted tracking sheet on the Internet.

June 18, 2004

July 9, 2004

Issued implementing instructions.