Radiology Coding Alert

Collect Reimbursement for DEXA Scans on Male Patients

Published on Tue Sep 23, 2003

Most radiology coders can easily rattle off the osteoporosis and postmenopausal-state ICD-9 Codes because these diagnoses are so often assigned to DEXA scan codes. But bone density studies aren't just for women: Medicare carriers across the country allow DEXA payment for gender-neutral diagnoses.

But because Medicare carriers also maintain restrictions and frequency guidelines on dual energy x-ray absorptiometry (DEXA) scans, coders shy away from reporting the three DEXA scan codes:

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)

0028T - Dual energy x-ray absorptiometry (DEXA) body composition study, one or more sites.

Osteoporosis (733.00) is probably the first diagnosis that you think about when addressing DEXA scans, but it may not comprise the majority of your bone density screening claims. "I would estimate that about 30 to 40 percent of our patients are imaged for osteopenia or osteoporosis," says Carrie Caldewey, RCC, CPC, coding specialist at Redwood Regional Medical Group in Santa Rosa, Calif. "The rest are being followed up for corticosteroid use, use of Fosamax, or screening for osteoporosis based on their postmenopausal state."

Differentiate Screening From Diagnosis or Follow-Up

Medicare carriers routinely include a notation in local medical review policies (LMRPs) indicating that "screening bone densitrometry in males is not covered by statute." Radiology Coder often see this statement and immediately grab an advance beneficiary notice (ABN) whenever a male patient is scheduled for a DEXA. But you should hold that ABN until you look further at your carrier's policy.

Carriers may limit screening DEXAs to estrogen-deficient women, but LMRPs usually contain separate listings of ICD-9 codes that apply to diagnostic exams, says Jeff Fulkerson, BA, CPC, CMC, certified coder for the department of radiology at The Emory Clinic in Atlanta. The Iowa Medicare LMRP lists several diagnosis codes that apply to "diagnostic testing or follow-up treatment of either sex as appropriate."

The following codes represent a small sample of Iowa's listing:

252.0 - Hyperparathyroidism

733.13 - Pathologic fracture of vertebrae

806.5 - Lumbar vertebral fracture, open

E932.0 - Adrenal cortical steroids.

Remember that you should never report an E code such as E932.0 as your primary diagnosis. If you perform DEXA to evaluate patients on steroids such as prednisone, you should list V58.69 (Long-term [current] use of other medications; high-risk medications) as your primary diagnosis and E932.0 as your secondary diagnosis. Cahaba GBA, a Part B carrier in Alabama, Georgia and Mississippi, reimburses DEXAs for patients who have taken (or will take) glucocorticoid therapy (equivalent to 7.5 mg of prednisone or more per day) for more than three months.

Don't Employ Blanket ABNs

Because DEXA claims are often denied as "preventive" or "screening" services, if osteoporosis is not found, some practices routinely ask every patient, regardless of diagnosis, to sign an ABN. Although radiology practices may think that this is an efficient way to "cover" their bases if a DEXA scan is denied, this type of waiver won't hold up to an audit.

An ABN must be specific about why the individual service may not be covered. In addition, specificity allows the patient to be an informed consumer and reject the service if he or she chooses, based on the information provided. If, however, you have a strong basis for believing that a claim will be denied, your practice is justified in obtaining an ABN. Under any circumstance, it is imperative that the ABN state the reasons for potential nonpayment.