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Radiology Coding Alert

Bone Up on Diagnosis Codes for Density Studies

Published on Fri Mar 01, 2002

Over the past several years, Medicare has gradually expanded the list of diagnosis codes that support medical necessity for diagnostic bone density scans. However, because it is statutorily prohibited from paying for many screening services, Medicare does not unilaterally pay for bone density studies performed on beneficiaries who exhibit no related symptoms (although some local carriers have added V82.81, Special screening for other conditions, other specified conditions, osteoporosis to the list of approved diagnosis codes supporting specific bone scans). This requires radiology coders to pay close attention to physician documentation so proper ICD-9 Codes can be assigned and payment achieved.
 
Bone mineral density (BMD) studies are most often performed to establish the diagnosis of osteoporosis, according to Jean Stoner, CPC, manager of coding operations at CodeRyte, an Internet-enabled coding service and software provider based in Bethesda, Md. She adds that more studies are being done because people are living longer and more women are reaching menopause. As a result, many physicians are beginning estrogen replacement therapy (commonly known as hormone replacement therapy or HRT) in their female patients and are ordering baseline bone density studies to monitor the risk for osteoporosis. While this desire for a baseline study is understandable, most carriers dont consider fear of osteoporosis alone a reason for a bone density scan. Instead, payers look for a definitive, clinical and medically necessary reason for the study.

Technology Determines Procedure Code
 
BMDs can be conducted using technologies such as single photon absorptiometry (SPA), dual photon absorptiometry (DPA), dual energy x-ray absorptiometry (DEXA), portable dual energy x-ray absorptiometry, radiographic absorptiometry, quantitative computed tomography (QCT), and broadband ultrasound attenuation (BUA). CPT Codes provides a range of codes that describe the services provided during the scans:

  76070 Computerized axial tomography bone density study, one or more sites

  76075 Dual energy x-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)

  76076 appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

  76078 Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), one or more sites

  76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method

  78350 Bone density (bone mineral content) study, one or more sites; single photon absorptiometry

  78351 dual photon absorptiometry, one or more sites.
 
While these codes may be used when reporting claims to private insurers, Medicare policy differs, according to Charlene Finchum, CPC, coding specialist and supervisor for the department of radiological sciences at the University of Oklahoma Health Sciences Center in Oklahoma City. In fact, CMS has assigned 76070 an I or  inactive status and has implemented a series of HCPCS G codes to be used in its place:

  G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

  G0131 Computerized tomography bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine)

  G0132 appendicular skeleton (peripheral)    (e.g., radius, wrist, heel).
 
In some areas, Medicare generally does not cover dual energy and single photon bone density studies for any condition other than an established diagnosis of osteoporosis. In addition, dual photon absorptiometry (78351) is not covered by Medicare for any condition because it is still considered investigational. Coders should carefully follow local medical review policies regarding any bone scan coding.

Diagnosis Codes Vital for Payment
 
It appears that more conditions are being recognized when reporting these studies, Stoner notes, including a number of indications that are considered risk factors for osteoporosis. These include a family history of the disease, some long-term steroid therapies that affect bone mass, and hyperparathyroidism, which affects the bodys ability to metabolize calcium. The list of ICD-9 codes that constitute medical necessity vary greatly from one carrier to the next, and coders should ask their local payers for the latest list.
 
Categories of conditions include:

  women who are estrogen-deficient and at clinical risk for osteoporosis, based on medical history and other findings (e.g., 627.2, Menopausal or postmenopausal disorders; menopausal or female climacteric states; or 627.8, Other specified menopausal and postmenopausal disorders)

  an individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass) or vertebral fracture (e.g., 805.2, Fracture of vertebral column without mention of spinal cord injury, dorsal [thoracic], closed; or 806.4, Fracture of vertebral column with spinal cord injury, lumbar, closed) 

  an individual receiving or expecting to receive glucocorticoid (steroid) therapy for more than three months (e.g., V58.69, Long-term [current] drug use, long-term [current] use of other medications)

  an individual with primary hyperparathyroidism or other specific endocrine disorders (e.g., 244.0-244.9, Acquired hypothyroidism; or 252.0, Hyperparathyroidism)

  an individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy (e.g., V58.69).
 
Note: Do not assume that simply because a female is postmenopausal she is estrogen-deficient or has ovarian failure. Coders must be careful not to label the patient with a condition she does not have.
 
Unless greater frequency is medically necessary, Medicare generally covers bone density scans once every two years.

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