Medicare Compliance & Reimbursement

Question: If a patient has had DEXA exams for years and our doctor treated her for osteopenia, is this still considered a routine screening test? My colleague billed it with an osteopenia diagnosis and the payer applied this visit to the deductible. The patient says the DEXA scan is a screening exam and covered 100 percent. Does the DEXA scan qualify as a screening exam?

Answer: If the reason the doctor performed the DEXA scan (77080, Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) was because the patient had a previous DEXA that showed osteopenia, it is not a screening exam.

However, if the doctor ordered it before a diagnosis was made and the result shows osteopenia (733.90, Disorder of bone and cartilage, unspecified), then this is still a screening exam and the screening diagnosis (V82.81, Special screening for other conditions; osteoporosis) would be the primary Dx, followed by the finding.

ICD-10: When your diagnosis coding system changes in 2013, 733.90 will expand into M85.819-M85.9 (Other specified disorders of bone density and structure).

Caution: If you looked up 733.90 in one of the current ICD-9 to ICD-10 translator tables, it would lead you to M89.9 (Disorder of bone, unspecified) and M94.9 (Disorder of cartilage, unspecified), but if you look up the term "osteopenia" in the ICD-10 alphabetic index, you are lead to the M85.8XX codes. You'll select the correct code based on the limb or limbs that are affected by osteopenia.

For instance, you might report M85.871 (Other specified disorders of bone density and structure, right ankle and foot) and V82.81, which is Z13.820 (Encounter for screening for osteoporosis) in ICD-10.