Radiology Coding Alert

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 [...]