Carriers May Not See Medical Necessity for 76077

New DEXA code allows you to report vertebral fracture assessment scans

Warning: You may be wasting your time if you report new DEXA code 76077 without confirming coverage first.
 
Starting Jan. 1, both endocrinology and radiology practices may find use for 76077 (Dual energy x-ray absorptiometry [DXA], bone density study, one or more sites; vertebral fracture assessment). "The new CPT code covers vertebral fracture assessment scans," such as Instant Vertebral Assessment (IVA) by Hologic and Lateral Vertebral Assessment (LVA) by GE Lunar Medical Systems, says Tom Weber, MD, endocrinologist with Duke University Medical Center in Durham, N.C.
 
How it works: Physicians can obtain lateral spine images using dual x-ray absorptiometry (DXA), allowing them to screen for vertebral fractures at the same time a patient is undergoing assessment of bone mineral density.
 
Problem: On March 19, 2004, Blue Cross of Georgia published a medical policy for vertebral fracture screening that casts a shadow over future payment prospects for 76077, says Jeff Fulkerson, BA, CPC, senior certified coder in the radiology department of Emory Health Care in Atlanta. The policy states: "Screening for vertebral fractures using dual x-ray absorptiometry as an adjunct to bone mineral density measurement is considered investigational/not medically necessary."
 
Solution: Because carriers will likely apply this "not medically necessary" policy to new code 76077, you need to check with your payers before performing and billing this service.
76077 Doesn't Affect Other Codes
New code 76077 reports vertebral fracture screening but "will not supplant DXA for diagnostic assessment of bone mineral density (BMD) (76075 and 76076)," Weber says. You should still report these codes as you normally would.
 
DEXA or DXA? You may notice that CPT 2005 changes the code descriptors for 76075-76077 to "DXA," whereas in the past the acronym was written "DEXA." This change doesn't means there have been any changes in terminology or process, Weber says. "The term 'DXA' is the proper term, and the powers-that-be are just getting around to correcting it."
 
Note: You can read Blue Cross of Georgia's entire medical policy at provider.bcbsga.com/provider/medpolicy/policies/radiology/vertebral_fractures_DEXA.html.

- Published on 2004-11-21