Ob-Gyn Coding Alert

Ob/gyn coders who submit Medicare claims for DEXA bone scans (76075, dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine] or 76076, dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; appendicular skeletal [peripheral] [e.g., radius, wrist, heel]) have often struggled to gain reimbursement for these claims. This is due both to Medicare restrictions on the need and frequency of the exams and limits in accompanying diagnostic codes to justify the scans. But with the addition of some new ICD-9 codes, effective Oct. 1, 2000, justifying a DEXA scan for women at risk for osteoporosis may be easier. As with all Medicare coverage, the ability to use new codes depends on carriers willingness to update their systems to use the newly available information, but the codes should make reimbursement for these tests less challenging.

Understand the Diagnostic Options

DEXA scans are used to screen for osteoporosis. Consequently, many Medicare patients, particularly women, receive this test and more women are undergoing the test than ever before. There is an increased awareness among physicians for the need to monitor bone loss in women, says Philip Eskew, MD, medical director of Womens and Childrens Services at St. Vincent Hospital in Indianapolis. In many cases, the test is the convincing reason for a patient to undergo estrogen replacement therapy when she may be reluctant to do so. DEXA scans enable physicians to track bone loss in a patient, as well as monitor the positive effects of estrogen therapy. The bottom line is that people are living longer, and they need to think about their lifestyle and steps to make the most of their later years, Eskew adds.

Justifying bone density studies has been difficult in the past. Most carriers have created lists of covered diagnoses that do not always correspond with the reason the patient is suspected of developing osteoporosis. Melanie Witt, RN, CPC, MA, an independent ob/gyn coding educator in Fredericksburg, Va., warns, however, that under Medicare coverage there is a big difference between performing a test to diagnose a problem versus routinely screening for a condition. The bone density study benefit is not for routine screening, she says. The physician must have documented that based on symptoms and/or medical history, the patient is at high risk for developing osteoporosis. The purpose of the scan is to confirm or eliminate this diagnosis. With many Part B and commercial carriers, the only diagnosis accepted with 76075 or 76076 was 781.9 (other symptoms involving nervous and musculoskeletal systems). This nonspecific diagnosis often resulted in rejected claims.

Now, however, 781.9 [...]