Medicare covers DXA Bone Densitometry for certain Medicare beneficiaries who fall into at least one of the following categories: 1.) A woman whose doctor has determined she's estrogen-deficient and at a clinical risk for osteoporosis, based on her medical history and other findings.
820.
77085: Dual-energy X-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine), including vertebral fracture assessment.
77080CodeDescriptionM85.841Other specified disorders of bone density and structure, right handM85.842Other specified disorders of bone density and structure, left handM85.851Other specified disorders of bone density and structure, right thighM85.852Other specified disorders of bone density and structure, left thigh124 more rows
To make sure you meet the criteria to have your bone density test fully covered by Medicare, you doctor needs to provide documentation that you meet one of the following conditions: You require the test for a medical reason, such as high risk for osteoporosis, osteopenia, sudden pain, or an injury.
Medicare will always deny Z13. 820 if it is the primary or only diagnosis code. The Medicare national coverage determination (NCD) can be found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1580OTN.pdf.
Z13. 820 Encounter for screening for osteoporosis - ICD-10-CM Diagnosis Codes.
Group 1. * Per CMS IOM Publication 100-04, Chapter 13, Section 140.1, CPT code 77080 or CPT code 77085 is covered when used to monitor FDA-approved osteoporosis drug therapy subject to the 2-year frequency standards described by CMS IOM Publication 100-02, Chapter 15, Section 80.5.
A bone density scan uses low dose X-rays to see how dense (or strong) your bones are. You may also hear it called a DEXA scan. Bone density scans are often used to diagnose or assess your risk of osteoporosis, a health condition that weakens bones and makes them more likely to break.
Medicare will cover DEXA bone mass measurement once every 2 years on a person who falls into 1 out of the 5 Following categories: 1. A woman who has been determined by her physician to be estrogen-deficient and at clinical risk for osteoporosis. 2.
DXA can also be used to measure peripheral sites, such as the wrist and finger. DXA generates 2 x-ray beams of different energy levels to scan the region of interest and measure the difference in attenuation as the low- and high-energy beams pass through the bone and soft tissue.
DXA is probably the most commonly used technique to measure BMD because of its ease of use, low radiation exposure, and its ability to measure BMD at both the hip and spine. DXA can also be used to measure peripheral sites, such as the wrist and finger. DXA generates 2 x-ray beams of different energy levels to scan the region of interest and measure the difference in attenuation as the low- and high-energy beams pass through the bone and soft tissue. The low energy beam is preferentially attenuated by bone, while the high energy beam is attenuated by both bone and soft tissue. This differential attenuation between the 2 beams allows for correction for the irregular masses of soft tissue, which surround the spine and hip, and therefore the measurement of bone density at those sites.
a. A FRAX Assessment is done to identify patients for BMD testing when any of the following criteria are met:
ICD-9-CM code 733.90 should be reported to indicate osteopenia, (only when billing 77080-DXA), when used to follow treatment with FDA approved osteoporosis medications.
CPT 77085 should NOT be billed for screening and is not part of the Preventive Benefit. Member cost share will apply when medically necessary criteria are met.
Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied (e.g., if the spine and hip are studied, Procedure code 77080 should be billed only once).
A dexa scan for a cancer patient is usually performed for staging purposes and is coded using the cancer diagnosis.
You may add 733.90 as a secondary diagnosis, but you cannot make it your primary diagnosis. "A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems.
Click to expand... Yes. You can code it with osteopenia.
Sorry there is no confusion here, when the test is ordered as a screening then screening is the first listed dx code regardless of the findings. This per the coding guidelines which are HIPAA mandated to be followed. In addition you are changing the parameters of the test, the patient was asymptomatic upon presentation with no reason to believe there would be anything other than a clean result. If the payer does not pay for the screening then the patient should know this prior to the test. Findings during a screening are incidental to the expectation that the patient would be as healthy as they appear. Incidental findings are always secondary dx codes. Please do not assign dx codes just because it is the one that gets paid!
Yes. You can code it with osteopenia.
You absolutely may not code the diagnosis as the first listed you must code screening first listed if the reason for the test was screening. The pate was asymptomatic if this was a screening and you cannot change the parameters of the reason for the test and "make the patient symptomatic" the findings were not expected and not wat was being investigated so the findings are incidental. I am sorry that the patient wil have to pay but they should have known that when they agreed to the screening.
Many medications available today can slow the rate of bone loss and, in some cases, even rebuild bone strength.
Postmenopausal women, men ages 70 and older, or those who recently suffered from a broken bone are advised to take a bone density test. Women are at high risk for osteoporosis. Bone loss is women is fastest during the first few years after menopause and continues into old age.
Osteoporosis is a medical condition characterized by architectural weakening in the bones and decreased bone mass. These changes make the bones more fragile and increase the risk of fractures, especially at the spine, hip, and wrist.
When you think of osteoporosis, you likely think of women. It is true that postmenopausal women are at highest risk for the condition. Once their bodies no longer produce premenopausal levels of estrogen, the protective benefits of the hormone on their bones go away.
Fortunately, Medicare feels that bone health is essential and can help you get excellent bone care, whether it be testing or treatment. There are about 10 million people in the United States alone with Osteoporosis and almost 34 million more with low bone mass.
Bone density testing is typically done in a clinical setting such as a hospital or an outpatient facility. After putting on a loose gown, youll be asked to lie on a padded platform. A suspended mechanical arm then passes over parts of your body, taking images of your skeleton.
Supplemental plans fill in the gaps by covering the 20% you would otherwise pay under Part B. By relieving you of this cost, you can worry less about bills and more about recovery. The best part about a supplement is that when Medicare approves a service, the supplement must authorize the service as well.
Documentation requirements: The procedure must be ordered by a physician or qualified practitioner after a complete assessment of the patient’s condition determines that a bone mass measurement is medically necessary. If diagnosis, frequency, or documentation does not support medical necessity, coverage will be denied.
Bone density can be measured at the wrist, spine, hip or calcaneus . The medical literature is divided on the accuracy of predicting osteoporosis of the spine or hip by measuring peripheral sites (wrist, calcaneus). It does appear, however, that measurement of bone density of the bone involved gives a better measurement of osteoporosis than does measurement of another bone not known to be involved.
Precise calibration of the equipment is required for accuracy and to reduce variation of test results and risk of misclassification of the degree of bone density. Lack of standardization in bone mineral measurement remains an issue, and tests are best done on the same suitably precise instrument to insure accuracy. It is important to use results obtained with the same scanner when comparing a patient to a control population, as systematic differences among scanners have been found. To ensure reliability of bone mass measurements, the densitometry technologist must have proper training in performing this procedure. Malpositioning of a patient or analyzing a scan incorrectly can lead to great errors in bone mineral density studies.
The basic clarification is that Medicare allows codes other than CPT code 77080 (i.e., 76977, 77078, 77079, 77081, 77083, and G0130) to be paid even though claims for such services report both a screening diagnosis code and an osteoporosis code.