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ICD-10/R97.21

R97.21 ICD-10-CM Code: Rising PSA following treatment for malignant neoplasm of prostate

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

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, 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.

Official Registry Overview & Definition

Rising PSA following treatment for malignant neoplasm of prostate is a billable ICD-10-CM diagnosis code (R97.21).

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Rising PSA following treatment for malignant neoplasm of prostate
    FY2017 changes

Verify Before Coding

  • Billable — reportable as written.
  • Age-restricted: the Medicare Code Editor lists this as a 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.

Contextual Map

Every relationship of R97.21 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.

Hierarchy

  • R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99) [Hierarchy]
  • R97-R97 — Abnormal tumor markers [Hierarchy]

Referenced by Excludes2 notes

  • R83 — Abnormal findings in cerebrospinal fluid [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89) [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R84 — Abnormal findings in specimens from respiratory organs and thorax [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R85 — Abnormal findings in specimens from digestive organs and abdominal cavity [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R86 — Abnormal findings in specimens from male genital organs [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R87 — Abnormal findings in specimens from female genital organs [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R88 — Abnormal findings in other body fluids and substances [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together
  • R89 — Abnormal findings in specimens from other organs, systems and tissues [Excludes2](via R97.-): “abnormal tumor markers (R97.-)” · check together

Referenced by Use Additional Code instructions

  • C61 — Malignant neoplasm of prostate [Use Additional Code]: “rising PSA following treatment for malignant neoplasm of prostate (R97.21)” · check together

Clinical classification (CCSR)

  • SYM017 — Abnormal findings without diagnosis [CCSR]

Potential MS-DRG

  • DRG 947 — SIGNS AND SYMPTOMS WITH MCC [MS-DRG]: “SIGNS AND SYMPTOMS WITH MCC (MDC 23)”
  • DRG 948 — SIGNS AND SYMPTOMS WITHOUT MCC [MS-DRG]: “SIGNS AND SYMPTOMS WITHOUT MCC (MDC 23)”

MDC crossing · procedures (1235)

  • 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.”
  • F003GKZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Audiovisual Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Audiovisual Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GMZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Augmentative / Alternative Communication Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Augmentative / Alternative Communication Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GPZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Computer [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Computer — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GYZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Other Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Other Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GZZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • and 1230 more

Index entries

  • Rising, PSA following treatment for malignant neoplasm of prostate[Index term]

Nearest codes

  • R97 — Abnormal tumor markers [Sibling]
  • R97.0 — Elevated carcinoembryonic antigen [CEA] [Sibling]
  • R97.1 — Elevated cancer antigen 125 [CA 125] [Sibling]
  • R97.2 — Elevated prostate specific antigen [PSA] [Sibling]
  • R97.20 — Elevated prostate specific antigen [PSA] [Sibling]
  • R97.8 — Other abnormal tumor markers [Sibling]

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

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.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

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.

Official ICD-10-CM tabular notes on other codes that name R97.21 or its code family.

8 Excludes2 notes: R83 (via R97.-), R83-R89 (via R97.-), R84 (via R97.-), R85 (via R97.-), R86 (via R97.-), R87 (via R97.-), R88 (via R97.-), R89 (via R97.-).

1 Use Additional Code instructions: C61.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R97.21 in its code family, with their registry titles.

  • R97 — Abnormal tumor markers
  • R97.0 — Elevated carcinoembryonic antigen [CEA]
  • R97.1 — Elevated cancer antigen 125 [CA 125]
  • R97.2 — Elevated prostate specific antigen [PSA]
  • R97.20 — Elevated prostate specific antigen [PSA]
  • R97.8 — Other abnormal tumor markers

View all codes in the R97 family

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Rising, PSA following treatment for malignant neoplasm of prostate