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Internal Medicine Coding Alert

Reader Questions:

Get a Grip on Bone-Density Studies

Published on Wed Jan 26, 2005

Question: What are Medicare's requirements for reporting bone-density studies?

Pennsylvania Subscriber
 
Answer: Medicare covers bone-density studies when your physician monitors patients to assess an FDA-approved osteoporosis drug therapy's response or efficacy. Also, women are eligible for coverage if they are estrogen-deficient and at clinical risk for osteoporosis. Estrogen-deficient means that a female patient cannot be on hormone replacement therapy.

Medicare also covers bone-density studies for patients who meet three criteria:
 

  •  a patient with vertebral abnormalities, as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass) or vertebral fracture;
     
  •  a patient with known primary hyperparathyroidism; and
     
  •  a patient receiving (or expecting to receive) cortico-steroid therapy (greater than three months or the equivalent dose of 30 mg cortisone [or 7.5 mg prednisone] or greater per day).

    The patient's physician or qualified nonphysician practitioner (this includes a consulting physician or specialist) must provide an order for the bone-density study. You could receive a denial if one of these entities did not order the study.

     - Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a training manager at QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.

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