# Dexa/bone density dx ?



## Kimberley (Jul 17, 2009)

Order states SCREENING

Report impression states.....OSTEOPOROSIS

What is the correct/proper way to code these?  V82.81/733.00 or just 733.00


Does anyone have any information on billing for DEXA's/BONE DENSITYS??

Thanks so much

Kimberley Tober, CPC
Franklin, TN


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## heiditipherwell (Jul 17, 2009)

If the impression clearly states that they have osteoporosis, then I would just use the 733.00.


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## Kimberley (Jul 17, 2009)

Even though it was ordered as a screening?


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## lrcarver (Jul 17, 2009)

If you have a confirmed Dx of Osteoporosis then bill with 733.00.  If you only have the Dx the Dr ordered the test with use V82.81.  Medicare also has an NCD policy on Bone Density testing.


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## mitchellde (Jul 19, 2009)

No if the order was for screening then the first listed dx must be screening any dx discovered during the screening process is incidental and secondary.  The guidelines for coding and reporting have a section on screening.


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## Joe_coder07 (Jul 21, 2009)

I do think we can go with 733.00 only as the dx was confirmed in the end


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## melissa meader (Jul 21, 2009)

when I code dexa I code the test not the screening so if the patient has 
osteopenia, menopause,hx. fx, that is what i could if you read the coding  guidelines  it says "For outpatient encounters for diagnostic test that have been interpreted by a physician,and the final report is available at the time of coding,code any confirmed or definitive diagnosis(es) documented in the interpretation. Do Not code related signs or symptoms as additional diagnoses."  
mmeader,maine


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## mitchellde (Jul 21, 2009)

Yes that is true IF the test were for diagnostic purposes.  If the test is for screening then there were no signs and symptoms.  The guidelines state that if the purpose was for screening then screening remains the first-listed dx regardless of the findings.  The section Melissa is referring to is for diagnostic exams and does not override the screening guideline.  We must be consistent with our coding and follow the guidelines for codeing and reporting.  When you say the diagnosis was confirmed in the end then you are saying that this was not screening, for screening is not looking to confirm any dx, it is looking for a healthy patient.  If the patient has symptoms then it is not screening.


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## LTibbetts (Jul 21, 2009)

I agree with Deb. The guidelines are VERY specific about "Screening" coding. You can use the Osteo as a secondary dx but the patient came in for a screening so you should go by the screening guidelines, especially for Medicare


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