Primary Care Coding Alert

Do you know when you can bend the two-year rule?

Bone density screenings, or bone mass measurements (BMMs), are an important part of your provider’s care plan for patients with osteoporosis or osteopenia. But when are patients eligible for BMM? And what ICD-10 codes will your need to report for the screenings?

Here’s all the information you need in one handy guide.

Know Patient Eligibility and Eligible Conditions

Before submitting a claim for BMM, you’ll need to confirm if the patient qualifies for the procedure. Essentially, “women of postmenopausal age, women who may be estrogen deficient and at risk for osteoporosis, men or women receiving a steroid or osteoporosis therapy, and patients with hyperparathyroidism should be screened for bone density,” says Dianne Nakvosas, ACS-RAD, Senior Medical Coder at Compubill, Inc., Tinley Park, Illinois.

This is confirmed in Chapter 15, Section 80.5 of the Medicare Benefit Policy Manual, which can be found at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf. In it, Medicare declares the following eligible for BMM:

1. A woman who has been determined by the physician or qualified nonphysician practitioner treating her to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other findings.
2. An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.
3. An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months.
4. An individual with primary hyperparathyroidism.
5. An individual being monitored to assess the response to or efficacy of an FDA approved osteoporosis drug therapy.

Know These BMM-Related Dx Codes

For eligible patients without an established diagnosis of osteoporosis or osteopenia, you will need to use codes that closely represent some of the Medicare-covered conditions listed above, such as:

• E28.39 (Other primary ovarian failure) (which describes a state of decreased estrogen, per the code’s synonym)
• E21.0 (Primary hyperparathyroidism)
• M89.9 (Disorder of bone, unspecified)
• M94.9 (Disorder of cartilage, unspecified)
• N95.1 (Menopausal and female climacteric states)
• Z79.52 (Long term [current] use of systemic steroids)

Additionally, if your clinician is performing the screening on a woman who has reached menopause but has no other symptoms, you will report Z78.0 (Asymptomatic menopausal state) and Z13.820 (Encounter for screening for osteoporosis) for the encounter to support medical necessity for the screening.