# Coding Dexa scan



## susie09

My physician orders Dexa scan with a  screening diagnosis, which Medicare doesn't cover, Can anybody tell me if the results come out positive for osteopenia can I code it with osteopenia or do I have to code it as a screening and make the patient responsible for the first test.


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## dearvinh

susie09 said:


> My physician orders Dexa scan with a  screening diagnosis, which Medicare doesn't cover, Can anybody tell me if the results come out positive for osteopenia can I code it with osteopenia or do I have to code it as a screening and make the patient responsible for the first test.



Yes.  You can code it with osteopenia.


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## Rajebpt

Hi
  yes you can code the coverable diagnosis 733.90 as the primary diagnosis n this case


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## donnajrichmond

If this was ordered as screening, then screening must be your primary diagnosis.  You may add 733.90 as a secondary diagnosis, but you cannot make it your primary diagnosis.  

Look at the Official Guidelines for ICD-9-CM: 
"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. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.
Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis."
And from CMS in the Claims Processing Manual, Chapter 23
"10.1.5 - Diagnostic Tests Ordered in the Absence of Signs and/or
Symptoms
(Rev. 1, 10-01-03)
When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of
illness or injury, the testing facility or the physician interpreting the diagnostic test should
report the screening code as the primary diagnosis code. Any condition discovered during
the screening should be reported as a secondary diagnoses."


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## mitchellde

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.


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## susie09

Thanks, for all your help, this helps me alot


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## jgf-CPC

If the result is osteopenia as you have said then you would not have to use the screening code unless you wanted to add it as secondary. I feel some people in this post were confused by all the answers. Medicare will pay the osteopenia code of 733.90 that the test has actually shown.


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## donnajrichmond

jgf-CPC said:


> If the result is osteopenia as you have said then you would not have to use the screening code unless you wanted to add it as secondary. I feel some people in this post were confused by all the answers. Medicare will pay the osteopenia code of 733.90 that the test has actually shown.



Medicare will pay the osteopenia code, but if they didn't know she had osteopenia prior to the exam being done, and if the patient did not have any of the other qualifying circumstances, then putting 733.90 as the primary diagnosis is fraud.  A screening exam must have the screening diagnosis as the primary diagnosis regardless of findings.


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## mitchellde

jgf-CPC said:


> If the result is osteopenia as you have said then you would not have to use the screening code unless you wanted to add it as secondary. I feel some people in this post were confused by all the answers. Medicare will pay the osteopenia code of 733.90 that the test has actually shown.



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!


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## inmanl

*Dexa*

If you were an Oncology Physician ordering dexa after a Cancer patient has had Chemo, how should it be coded and would it be payable?


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## mitchellde

A dexa scan for a cancer patient is usually performed for staging purposes and is coded using the cancer diagnosis.


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## LOVETAMBRA

Am I confused I thought that Medicare would not pay unspecified codes. 733.90 is osteopenia, unspecified.


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## lissa226

*Visit to follow DEXA*

I need to know how to code the visit that immediately follows the scan to discuss the result. I understand that the DEXA is coded as the screening, but if the result is osteopenia, is the E/M visit coded as osteopenia or is the screening primary and osteopenia secondary?


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