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Oncology & Hematology Coding Alert

Bone Mass Measurement:

77080 Has Multiple Medicare Hurdles That Could Trip Up Your Claims

Published on Thu Sep 13, 2012

Be prepared with these 5 tips on orders, frequency, coverage, and more.Prednisone may be helpful for reducing inflammation and its related pain in cancer patients, but it can also lead to bone loss. If your practice provides bone mass measurement (BMM) services for Medicare patients, these 5 tips should help keep your claims compliant.1. Verify Order Is From a Qualified Provider For Medicare to cover BMM, the test must be ordered by a physician or qualified nonphysician provider (NPP), according to Medicare Benefit Policy Manual (MBPM), Chapter 15, Section 80.5.4 (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf). NPPs qualified to order BMM include: Physician assistants Nurse practitioners Clinical nurse specialists Certified nurse midwives. The ordering physician or NPP must be treating the patient, evaluate the need for BMM, and determine the appropriate BMM for the patient. Treating means either consulting or treating the patient for a specific problem and using the results to manage the [...]
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