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R97.20 ICD-10-CM Code: Elevated prostate specific antigen [PSA]

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 947 — SIGNS AND SYMPTOMS WITH MCC (MDC 23)
  • MS-DRG 948 — SIGNS AND SYMPTOMS WITHOUT MCC (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coder workflow for R97.20

MedCoder structured workflow — derived from this code’s own official record

Before you code R97.20

  1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

    Guide: Symptom code vs confirmed diagnosis →

Choose the right path

  1. Is an established diagnosis that explains this sign or symptom documented?
    Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
    No → Continue — the sign or symptom code stands when no definitive diagnosis is established.

Consider R97.20. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The sign or symptom is documented, and the same record establishes a diagnosis that routinely includes it.

Coding question: Is R97.20 reported in addition to the diagnosis?

Path: Review the documented diagnosis and whether the classification treats this finding as integral to it.

Reason: Signs and symptoms integral to a confirmed diagnosis are not coded separately; those not routinely associated with it may be reported when present (Guidelines I.B.5, I.B.6, I.C.18.b).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Elevated prostate specific antigen [PSA] is a billable ICD-10-CM diagnosis code (R97.20).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • Questionable admission. The Medicare Code Editor lists this among its questionable-admission codes: reported as the principal diagnosis, it is not usually sufficient justification for an inpatient admission on its own, so it flags the admission as questionable. The code itself remains acceptable as principal.
  • Age-restricted: the Medicare Code Editor lists this as an adult (age 15-124) diagnosis; other ages are presumed incorrect.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name R97.20 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 8 Excludes2 notes: R83 — Abnormal findings in cerebrospinal fluid (via R97.-), R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89) (via R97.-), R84 — Abnormal findings in specimens from respiratory organs and thorax (via R97.-), R85 — Abnormal findings in specimens from digestive organs and abdominal cavity (via R97.-), R86 — Abnormal findings in specimens from male genital organs (via R97.-), R87 — Abnormal findings in specimens from female genital organs (via R97.-), R88 — Abnormal findings in other body fluids and substances (via R97.-), R89 — Abnormal findings in specimens from other organs, systems and tissues (via R97.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 947 (MDC 23), DRG 948 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM017 — Abnormal findings without diagnosis (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Abnormal findings without diagnosis).

R94.120 — Abnormal auditory function study, R94.121 — Abnormal vestibular function study, R94.128 — Abnormal results of other function studies of ear and other special senses, R94.130 — Abnormal response to nerve stimulation, unspecified, R94.131 — Abnormal electromyogram [EMG], R94.138 — Abnormal results of other function studies of peripheral nervous system, R94.2 — Abnormal results of pulmonary function studies, R94.30 — Abnormal result of cardiovascular function study, unspecified, R94.31 — Abnormal electrocardiogram [ECG] [EKG], R94.39 — Abnormal result of other cardiovascular function study, R94.4 — Abnormal results of kidney function studies, R94.5 — Abnormal results of liver function studies, R94.6 — Abnormal results of thyroid function studies, R94.7 — Abnormal results of other endocrine function studies, R94.8 — Abnormal results of function studies of other organs and systems, R97.0 — Elevated carcinoembryonic antigen [CEA], R97.1 — Elevated cancer antigen 125 [CA 125], R97.2 — Elevated prostate specific antigen [PSA], R97.21 — Rising PSA following treatment for malignant neoplasm of prostate, R97.8 — Other abnormal tumor markers, +183 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Elevated, elevation”; these codes share that main term but sit in a different category of the Tabular List.

I87.8 — Other specified disorders of veins (venous pressure), Q74.0 — Other congenital malformations of upper limb(s), including shoulder girdle (scapula, congenital), Q79.1 — Other congenital malformations of diaphragm (diaphragm, congenital), R03.0 — Elevated blood-pressure reading, without diagnosis of hypertension (blood pressure, reading, no diagnosis of hypertension), R17 — Unspecified jaundice (liver function, test, bilirubin), R50.9 — Fever, unspecified (body temperature), R70.0 — Elevated erythrocyte sedimentation rate (sedimentation rate), R73.01 — Impaired fasting glucose (fasting glucose), R73.02 — Impaired glucose tolerance (oral) (glucose tolerance), R73.9 — Hyperglycemia, unspecified (blood sugar), R74.01 — Elevation of levels of liver transaminase levels (AST), R74.02 — Elevation of levels of lactic acid dehydrogenase [LDH] (lactic acid dehydrogenaselevel), R74.8 — Abnormal levels of other serum enzymes (liver function, test, hepatic enzyme), R76.0 — Raised antibody titer (antibody titer), R76.89 — Other specified abnormal immunological findings in serum (immunoglobulin level), R79.82 — Elevated C-reactive protein (CRP) (C-reactive protein), R79.89 — Other specified abnormal findings of blood chemistry (troponin), R82.5 — Elevated urine levels of drugs, medicaments and biological substances (indoleacetic acid), R94.5 — Abnormal results of liver function studies (liver function, study), R94.8 — Abnormal results of function studies of other organs and systems (basal metabolic rate), +8 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Prostate-Specific Antigen (PSA)

Contextual Map

Every relationship of R97.20 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R97.20 with these 8 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services[MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,235 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Elevated, elevation, prostate specific antigen [PSA][Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "R97.20 — Elevated prostate specific antigen [PSA]." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/r97.20-elevated-prostate-specific-antigen-psa

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Elevated prostate specific antigen [PSA]
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R97.20 in its code family, with their registry titles.

View all codes in the R97 family