Orthopedic Coding Alert

Question: At our clinic, x-ray technicians perform DEXA scans, and orthopedic surgeons interpret the findings. Is there a code for in-house physician interpretation of these findings?


Florida Subscriber

Answer: Unfortunately, CPT does not contain a separate code for physician interpretation of dual energy x-ray absorptiometry (DEXA) scans or bone density studies. No separate code exists because the bone density study codes already include individual components that can describe the professional and technical portions of this service.

If you work in a physician-owned clinic and your clinic owns the DEXA equipment, you should report the global service code, such as 76075 (Dual energy x-ray absorptiometry [DXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) and 76076 (- appendicular skeleton [peripheral] [e.g., radius, wrist, heel]). You don't need to append modifiers in that situation.

But if the x-ray technicians work for a separate entity (such as a lab down the hall from your practice), you should code for only the physician component of the DEXA scan by appending modifier 26 (Professional component) to the study code. If you were instead billing for the technical component, you would attach modifier TC (Technical component) to 76075-76076.

Be careful: If you don't work in a physician-owned clinic with its own DEXA equipment, make sure the x-ray technicians don't report the global DEXA scan code. If you report the professional component and the x-ray coder bills for the complete DEXA scan service, you will be double-dipping on the professional portion of the study. Work with the x-ray coder to determine whether you should each bill for the DEXA scan's individual portions.

Also, if the orthopedist's interpretation is really a confirmation and reread of the DEXA scan--and the technician actually issues the written report--you should instead include the physician's work in the medical decision-making portion of the office visit or other E/M service.

For instance: When the patient returns for a face-to-face encounter in which the physician explains where she stands and how she compares to the -ideal- 30-year-old woman (T score) and also to other women her own age (Z score), you should use 99212-99214 (Office or other outpatient visit for the evaluation and management of an established patient ...).