ICD-10 Codes for PSA Screening
Use ICD-10 code Z12.5 (Encounter for screening for malignant neoplasm of prostate) as the primary diagnosis code when ordering PSA testing for prostate cancer screening in asymptomatic men.
Primary Screening Code
- Z12.5 is the appropriate ICD-10 code for routine PSA screening in men without symptoms or known prostate cancer 1
- This code applies to men aged 45-70 years undergoing baseline or follow-up PSA testing as part of prostate cancer screening 2, 1
Age-Specific Screening Indications
When ordering PSA screening, the appropriate age ranges supported by guidelines include:
- Age 45-49 years: Use Z12.5 for men with elevated risk (African American men or those with first-degree relative diagnosed before age 65) 2, 1
- Age 50-69 years: Use Z12.5 for average-risk men with at least 10 years life expectancy 2, 3
- Age 70+ years: Use Z12.5 only for very healthy men with minimal comorbidity and prior elevated PSA values; screening beyond age 70 generally not recommended 2, 3
Additional Risk-Based Codes
For men with specific risk factors requiring earlier screening:
- Z80.42 (Family history of malignant neoplasm of prostate) can be used as a secondary code when family history prompts screening at age 45 or 40 1
- Z15.03 (Genetic susceptibility to malignant neoplasm of prostate) for men with multiple first-degree relatives diagnosed before age 65 requiring screening at age 40 1
Common Documentation Pitfalls
- Avoid using symptom codes (such as R97.2 for elevated PSA) when ordering screening tests in asymptomatic men, as this may trigger diagnostic rather than preventive billing 1
- Do not use C61 (malignant neoplasm of prostate) for screening purposes; this is only for known cancer 2
- Ensure life expectancy documentation: Note that screening should only occur in men with at least 10 years life expectancy to justify the Z12.5 code 2, 3
Screening Interval Documentation
When ordering follow-up PSA after baseline: