evaluation. When a bone biopsy is used for bone density measurement, the covered indications are the same as other covered studies. When the service is provided for a non-covered or screening indication, the appropriate screening diagnosis code must be submitted as the reason for the service. 3. ICD-10 CM code Z90.721 or Z90.722 should be reported for women s/p oophorectomy. ICD-10
The ICD-10 code range for ICD-10 Disorders of bone density and structure M80-M85 is medical classification list by the World Health Organization (WHO).
CPT Code 77080 was mainly used for bone density scan of axial bones like hips and spine while 77081 was used to code axial bone like wrist, radius and heel etc. These codes were deleted in 2015 and two new codes were introduced for DEXA scan. These CPT Codes will include the old codes.
cpt code 78350, 78351, 77080 and 77086 - Medical Billing and Coding - Procedure code, ICD CODE. 78350: Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry 78351: Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry
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
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.
Encounter for screening for osteoporosis Z13. 820 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 Z13. 820 became effective on October 1, 2021.
Many ICD-10 codes cover fractures, but there are other ICD-10 codes Medicare will cover when used with a DXA Bone Scan (77080): 0 // Asymptomatic menopausal state. 3 // Long term (current) use of hormonal contraceptives.
Z13. 820 Encounter for screening for osteoporosis - ICD-10-CM Diagnosis Codes.
DXA is most often used to diagnose osteoporosis, a condition that often affects women after menopause but may also be found in men and rarely in children. Osteoporosis involves a gradual loss of bone, as well as structural changes, causing the bones to become thinner, more fragile and more likely to break.
Billing CPT 77080, 77081, 77082 with covered dxREIMBURSEMENT CODES FOR BONE DENSITOMETRY.CPT Code 77080 – Hip, spine or central DEXA (Dual Energy X-Ray Absorptiometry) studies. ... CPT Code 77081 – Peripheral DEXA Bone Mineral Density – $27.72.CPT Code 77082 – Peripheral Ultrasound Bone Mineral Density.Indications for DEXA.
Group 1CodeDescription77080DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)77085DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE), INCLUDING VERTEBRAL FRACTURE ASSESSMENT1 more row
A DEXA scan is a type of medical imaging test. It uses very low levels of x-rays to measure how dense your bones are. DEXA stands for “dual-energy X-ray absorptiometry.” Medical experts consider DEXA scans to be the most useful, easy, and inexpensive test for helping to diagnose osteoporosis.
According to a Medicare National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM), Z13. 820 Encounter for screening for osteoporosis is not covered by Medicare for a diagnostic lab testing service.
Bone mass measurements (also called bone density tests) can help determine if you need medical treatment for osteoporosis, a condition that can cause brittle bones in older adults. Medicare Part B covers bone mass measurement every two years if you are at risk for osteoporosis and have a referral from your provider.
CPT Code 77085 is a combination code that includes axial dual-energy X-ray absorptiometry (DXA) as well as VFA, while CPT 77086 represents a stand-alone VFA. The existing codes for axial and appendicular DXA studies (CPT 77080, CPT 77081) are not changing and will be used whenever DXA is performed without VFA.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L36356 Bone Mineral Density Studies provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials.
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.
Common diagnoses resulting from bone density studies may be reported with the following ICD-9-CM codes from Category 733 Other disorders of bone and cartilage:#N#733.0x Osteoporosis#N#733.1x Pathologic fracture#N#733.9x Other and unspecified disorders of bone and cartilage#N#Bone pain and other bone disorders may be coded from Category 719 Other and unspecified disorders of joint; or#N#733.90 Disorder of bone and cartilage, unspecified.#N#Report personal or family history of bone disorders with:#N#V13.89 Personal history of other specified diseases;#N#V17.81 Family history of osteoporosis; or#N#V17.89 Family history of other musculoskeletal disease.#N#Example 1: A 59-year-old man presents to his primary care physician (PCP) with the chief complaint of creaking knees: His knees ache and pop every time he rises from his living room sofa. He also has heard and felt occasional snaps in his groin and shoulder blades. The PCP does a limited exam of these three regions and orders bilateral X-rays of these regions.#N#CPT® codes:
The most common, accurate method to measure bone density involves dual energy X-ray absorptiometry (DXA). DXA projects two X-ray beams to better assess bone density and can detect a variance as small as 3 percent from one scan to the next. Conventional X-rays are not sensitive enough to detect such small variances. DXA is especially effective for full-body skeletal assessments, as well as for focused studies of the hip, spinal column, and forearm (the skeletal areas most likely to break).#N#During a DXA scan, the patient rests on a cushioned platform. Mechanical arms are placed under the X-ray table and are aligned with an X-ray detector placed above the patient’s body. The amount of X-ray energy absorbed by the bone is measured to determine the strength of that bone. Less energy will pass through healthy bone than through osteopenic or osteoporotic bone.#N#Aside from using DXA, a bone density study might be conducted using:
Aside from using DXA, a bone density study might be conducted using: Peripheral DXA (pDXA) – Portable machines used to measure bone density in the arms or legs.
Age is a key factor because the older a person gets, the more bone he or she tends to lose (reflected in ICD-9-CM classification as “Senile,” and in ICD-10-CM as “Age-related”). Gender is also a factor. Women are more prone to osteoporosis because they have smaller bones than men.
Quantitative ultrasound (QUS) – A portable machine used to measure bone density of the heel. Radiographic absorptiometry (RA) – This technique is most commonly used for bone density measurement at the hand or heel.
You break a bone after age 50. You are a woman of menopausal age with risk factors. You are a postmenopausal woman under age 65 with risk factors. You are a man age 50-69 with risk factors. Or a physician might order a bone density study for a patient who has had: An X-ray showing a spinal break or bone loss. Back pain.
by Ken Camilleis, CPC, CPC-I, CMRS, CCS-P#N#Bone density studies measure specific mineral values in targeted bony structures throughout the skeletal system, which allows a physician to diagnose osteopor osis (porous bone) or osteopenia (low bone density, the precursor to osteoporosis).
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.
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.
A. A one-time measurement of BMD, using one method only, may be considered medically necessary to assess fracture risk and the need for pharmacologic therapy in the following patients considered at risk for osteoporosis, who are also considering treatment to prevent osteoporotic fracture: 1.
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).
BCBSNC will provide coverage for Axial (Central) Bone Mineral Density (BMD) Studies when they are determined to be medically necessary because the medical criteria and guidelines shown below are met.
Priority Health will limit coverage for BMD studies to central DXA only. Any other BMD studies (e.g. peripheral, such as wrist, finger and heel) are not medically/clinically necessary and, therefore, not covered. BMD studies will not be prior authorized by Priority Health.
Routine Bone Density Studies#N#Routine bone density studies performed as a screening test for osteoporosis are eligible for members with coverage for Preventive Health services according to the preventive scheduled published annually. (Refer to the member's individual benefits for coverage information on this service.)
Coverage for eligible bone density studies is limited to one test every two (2) years from the date of the previous bone density study, regardless of the anatomic area tested or imaging modality used to perform the study.
Dual-energy X-ray Absorptiometry — (DXA) is recommended by the National Osteoporosis Foundation (NOF) for bone density test of the spine, hips and pelvis to diagnose osteoporosis. When testing can’t be done on the spine, hips and pelvis, NOF suggests a central DXA test of the radius bone in the forearm.
Quantitative computerized tomography — (QCT)is a type of computed tomography (CT) that provides accurate measures of bone density in the spine.Compared with DXA, QCT is less readily available and associated with relatively high radiation exposure.
Bone mineral density (BMD) testing is a widely available clinical tool for screening and diagnosing osteoporosis. These studies are also used to predict fracture risk and monitor response to therapy. Bone mineral density can be measured using different techniques in a variety of central (i.e., hip or spine) or peripheral (i.e., wrist, finger, heel) sites.
Breast cancer individuals who are on aromatase inhibitors. DXA for pediatrics (until age 19) may be considered medically necessary when ANY ONE of the following is met: Prolonged use of glucocorticoid or corticosteroid therapy; or.