Collecting for DEXA Scans? It's All About the Diagnosis

Answers to your most dire questions
Endocrinology coders have notoriously struggled to collect Medicare reimbursement for dual energy x-ray absorptiometry (DEXA) scans. CMS not only restricts the medical necessity and frequency of these exams but also limits the diagnoses that justify the scans. Follow our expert advice to determine whether your DEXA claims are airtight.
Physicians can order many different bone density studies, but "at this point in time, DEXA pretty much is the clinical gold standard for measuring bone density," says Jordan B. Renner, MD, professor of radiology and allied health sciences at University of North Carolina School of Medicine in Chapel Hill. We've listed five of the most common DEXA questions below -- with answers from the experts -- to sharpen your coding skills for these services.
1. What are the appropriate codes for a DEXA scan?
Answer: CPT provides three codes for DEXA scans:

76075 -- Dual energy x-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)
76076 -- ... appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
0028T -- Dual energy x-ray absorptiometry (DEXA) body composition study, one or more sites.
2. Does a DEXA scan need a written report?
Answer: Although most payers don't publish a set "recipe" for a proper written report, you should maintain a report on the DEXA scan results, because it is crucial if you plan to bill for the professional component of the exam (see our article "DEXA Coding 101: Append -26 for Second Opinions" for more information on whether you should report the global code or the professional component only).

Without a written report, you won't have evidence of your physician's service if a carrier asks for proof. The report should simply reflect the treating physician's opinion of the DEXA scan results, and you should keep a copy in the patient's chart, says Jeff Fulkerson, BA, CPC, senior certified coder in the radiology department of Emory Health Care in Atlanta.
3. How often can we bill Medicare for a DEXA scan?
Answer: Medicare may cover a bone density study for a patient once every two years, "if at least 23 months have passed since the month the last bone mass measurement was performed," according to CMS. However, if your endocrinologist believes that more frequent scans are medically necessary, Medicare may cover the service if the patient's medical record clearly documents the reason, Fulkerson says. For example, Medicare may cover more frequent DEXA scans to monitor patients on long-term glucocorticoid (steroid) therapy of more than three months.
4. What diagnoses does Medicare cover for DEXA scans?
Answer: Medicare provides an [...]

- Published on 2004-07-21