Code | Description |
---|---|
M80.8AXK | Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion |
In addition, ICD-10-CM diagnosis code range T38.0X5A - T38.0X5S was added to the “ICD-10 Codes that Support Medical Necessity” section of the LCD under “Group 1 Codes:” for HCPCS code J0897 (Prolia®). Also, the “Sources of Information” section of the LCD was updated.
Boniva® is a bisphosphonate that inhibits osteoclast activity and reduces bone resorption and turnover, leading to, on average, a net gain in bone mass. Boniva® is available in oral and IV forms.
Explanation of Revision: Based on an external correspondence and LCD reconsideration, this LCD was revised to add ICD-10-CM codes C90.00, C90.01, C90.02 and M84.50XA – M84.58XS to the “ICD-10 Codes that Support Medical Necessity” section of the LCD under “Group 4 Codes:” for HCPCS code J0897 (Xgeva®).
BONIVA is a prescription medicine used to treat or prevent osteoporosis in women after menopause. BONIVA helps increase bone mass and helps reduce the chance of having a spinal fracture (break). It is not known how long BONIVA works for the treatment and prevention of osteoporosis.
(L34639) Bone Mass Measurement ICD-10 Codes That Support Medical Necessity and Covered by Medicare Program: Group 1 Paragraph: Note: ICD-10 codes must be coded to the highest level of specificity.
ICD-10 CM code Z79. 83 should be reported for DXA testing while taking medicines for osteoporosis/osteopenia. ICD-10 CM code Z09 should be reported for an individual who has COMPLETED drug therapy for osteoporosis and is being monitored for response to therapy.
Boniva belongs to a class of drugs called bisphosphonates.
Z13. 820 Encounter for screening for osteoporosis - ICD-10-CM Diagnosis Codes.
Disorder of bone density and structure, unspecified M85. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M85. 9 became effective on October 1, 2021.
0 – Age-Related Osteoporosis without Current Pathological Fracture. ICD-Code M81. 0 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Age-Related Osteoporosis without Current Pathological Fracture.
osteoporosisMedicare will cover bone density scans for a person who meets certain medical requirements, such as osteoporosis risk factors. Identifying thinning bone or osteoporosis at early stages before a person breaks a bone can allow them to receive treatments that may help reduce the risk of broken bones.
CPT® Coding for Bone Density Studies 77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel).
Boniva, known by the generic name ibandronate, is a once-a-month pill prescribed to prevent or to treat bone loss from osteoporosis. The FDA officially approves Boniva only for treatment of postmenopausal women, as the clinical studies that led to approval mostly enrolled women.
Are Boniva and Fosamax the same? Boniva and Fosamax are second-generation bisphosphonates, but they are not exactly the same. Their biggest difference is in how they are dosed. Boniva can be given once monthly, while Fosamax can be given once daily or once weekly.
There are concerns about the long-term safety of bisphosphonates (such as Boniva) as long-term use has been associated with atypical femur fractures, osteonecrosis of the jaw, and esophageal cancer.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33270 Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications. Please refer to the LCD for reasonable and necessary requirements.
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications.
This LCD addresses “incident to” drugs that are not self-administered for certain patients with osteoporosis. The other indications for these drugs are also addressed.
The labeler code, product code, and package code segments of the National Drug Code number, separated by hyphens. Asterisks are no longer used or included within the product and package code segments to indicate certain configurations of the NDC.
The translation of the DosageForm Code submitted by the firm. The complete list of codes and translations can be found www.fda.gov/edrls under Structured Product Labeling Resources.
The labeler code, product code, and package code segments of the National Drug Code number, separated by hyphens. Asterisks are no longer used or included within the product and package code segments to indicate certain configurations of the NDC.
The labeler code and product code segments of the National Drug Code number, separated by a hyphen. Asterisks are no longer used or included within the product code segment to indicate certain configurations of the NDC.