ICD-10 Code for PSA Screening
For a patient requesting PSA screening without symptoms or known prostate disease, use ICD-10 code Z12.5 (Encounter for screening for malignant neoplasm of prostate).
Primary Screening Code
- Z12.5 is the appropriate ICD-10 code for asymptomatic men requesting PSA screening for prostate cancer detection 1
Alternative Codes Based on Clinical Context
If the patient has specific risk factors or clinical indications, consider these additional codes:
- Z80.42 - Family history of malignant neoplasm of prostate (if first-degree relative has prostate cancer) 1
- Z15.03 - Genetic susceptibility to malignant neoplasm of prostate (for high-risk populations) 1
- N40.0 - Benign prostatic hyperplasia without lower urinary tract symptoms (if BPH is present and PSA monitoring is indicated) 1
- N40.1 - Benign prostatic hyperplasia with lower urinary tract symptoms (if symptomatic BPH requires PSA assessment) 1
Age-Appropriate Screening Considerations
The appropriateness of ordering PSA screening depends on patient age and shared decision-making:
- Ages 50-69 years: Screening should involve shared decision-making discussion about benefits and harms; Z12.5 is appropriate after this discussion 1, 2
- Ages 45-49 years with high risk (African American men or family history): Z12.5 with Z80.42 or Z15.03 as secondary codes 1
- Age 70+ years: Screening is generally not recommended unless the patient has >10 year life expectancy and specifically requests it after informed discussion 1, 2
Important Clinical Caveats
Shared decision-making is essential - Major guidelines emphasize that PSA screening should only occur after discussing potential benefits (1.3 deaths prevented per 1000 men screened over 13 years) versus harms (false positives, overdiagnosis, treatment complications including incontinence in 20% and erectile dysfunction in 67% after prostatectomy) 1, 2
Insurance coverage considerations - While Z12.5 is the correct screening code, some insurers may require documentation of the shared decision-making discussion or may have specific coverage policies for PSA screening 1, 2
Do not use symptom codes for asymptomatic screening requests - codes like R97.2 (elevated PSA) should only be used for follow-up of previously elevated results, not initial screening 1
Screening intervals - If approved for screening, biennial testing may be as effective as annual testing, and the code Z12.5 can be used at each screening encounter 1