Panel recommends against PSA tests for healthy men

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Panel recommends against PSA tests for healthy men

Postby Bill Glasheen » Sun Oct 09, 2011 5:25 pm

Since I have training in biomedical engineering and have spent much of my professional life as a health services researcher, I often have friends approach me about their personal health issues. Note that I am not a doctor, and I don't play one on TV. That said, I read the literature and in general don't have a dog in the fight for or against any particular screening or therapy. My job as an outcomes researcher is to approach aspects of medical care - as seen in health care transaction data - and make objective assessments of what works and what doesn't. I have a narrow view in my perspective, but I do get to view the health care of literally millions and can view the health care process "in the field" where patients and their health care providers go about their everyday business.

That said... a report like this based on hundreds of articles from the medical literature has a lot of weight. And from what I know, it passes my "sniff test."

I have personally witnessed some aspects of prostate cancer, having just lost my father to it this year. No worries on that, by the way. He lived a very happy and productive 89 years, and we had plenty of time to savor the last few years with him. And thankfully I made a difference, keeping the health care system from delivering care my father did not want, and helping my dad understand the limits of what could and could not be done for him. He passed away with no 'woulda, coulda, shoulda' scenarios left behind, and his legacy lives on.

- Bill

Wall Street Journal wrote:
OCTOBER 7, 2011

Panel Faults Widely Used Prostate-Cancer Test


A key federal advisory panel is poised to recommend that healthy men shouldn't be screened with a widely used blood test for prostate cancer, indicating that the test offers more harm than benefit.

The U.S. Preventive Services Task Force will recommend a "D" rating for prostate specific antigen, or PSA, testing, said a person familiar with the draft document. A "D" rating means "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," according to the group's website. It also is a recommendation to "discourage use" of test or treatment.

The task force is set to make its proposal Tuesday, and then allow for a four-week comment period before issuing a final recommendation.

The task force is an influential group whose recommendations can influence coverage decisions by the federal Medicare program and other insurers.

The scientific findings behind the recommendation are scheduled to be published Monday by the Annals of Internal Medicine. A copy of the paper was obtained by the newsletter Cancer Letter, which posted the paper on its website Thursday night.

The paper concluded that after about 10 years, PSA screening "results in small or no reduction" in death from prostate cancer but is "associated with harms," including biopsies, other tests and treatments, "some of which may be unnecessary."

Virginia A. Moyer, who chairs the task force,declined to comment on what the updated advisory would be. She noted that the current guidance is that the evidence is insufficient to recommend for or against screening in men younger than 75. That recommendation was last updated in August 2008. "New evidence has become available, and we had to reconsider our statement," Dr. Moyer said.

The new report is the latest in a long-running controversy over the value of PSA screening. Advocates say the test, when given regularly to men age 50 and over, facilitates the discovery of the cancer at an early stage, improving the chances of successful treatment. Critics say the test has a significant rate of false positives—apparent detection of cancer that isn't confirmed with further tests—or that it identifies so-called indolent tumors that are ultimately of little health consequence. This leads to unnecessary biopsies and cancer treatments.

Because such interventions can lead to infections, impotence and incontinence, critics say the risks of testing often outweigh the benefit.

—Katherine Hobsonand Ron Winslowcontributed to this article.
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Re: Panel recommends against PSA tests for healthy men

Postby gmattson » Mon Oct 10, 2011 9:50 am

Just curious Bill. . .
What does a doctor charge for a prostrate biopcy?
"Do or do not. there is no try!"
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Re: Panel recommends against PSA tests for healthy men

Postby Bill Glasheen » Wed Oct 12, 2011 12:14 pm


I'm going to start by sharing this coding advice with you.

To accurately code a prostate needle biopsy with ultrasonic guidance and separate diagnostic transrectal ultrasound, report the following codes:

* 76872, to report the transrectal ultrasound;

* 76942, to report the ultrasonic guidance used to guide the needle biopsy of the prostate; and

* 55700, for the needle biopsy of the prostate.

Remember, the use of 76872 does not preclude reporting 76942.

If you keep in mind the intent of the ultrasound procedure codes, coding for the diagnostic ultrasound procedure is also straightforward.

The intent of code 76872 is to describe a diagnostic transrectal ultrasound. The intent of CPT code 76942 is to describe an ultrasound used to localize a mass or region to be biopsied with a needle, and to guide the needle into the mass or region. By defining the intent of each code, we see that each clearly represents a separate and distinct service. For reporting purposes, both procedures should be appropriately documented.

And that's just the cut (bad pun, I know...) for the urologist before the samples hit the lab. There's more revenue exchange after that with lab work, reading the results, follow-up visit(s) with patients, etc.

When I can reasonably look at this in my data (without unreasonably using company resources), I'll share some numbers with you.

- Bill
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