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 [...]
