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Coding Analysis for Labs (CAL) Tracking Sheet for Prostate Specific Antigen (Inclusion of ICD-9-CM Code 600.01 for BPH with Urine Obstruction) (CAG-00232N)

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.

Diagnostic Laboratory Tests
Requestor Name(s)Marcie Yoh; Good Samaritan Hospital; Baltimore, Maryland
Formal Request Accepted and Review Initiated03/18/2004
Expected NCA Completion Date06/17/2004
Public Comment Period03/19/2004 - 04/19/2004
Decision Memo Released06/18/2004
Lead Analyst(s)
  • Jackie Sheridan-Moore

March 19, 2004

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

June 18, 2004

July 9, 2004

Issued implementing instructions.