Radiology Coding Alert

Question: A patient presents to the office for screening DXA bone density test, but the order from her doctor states osteopenia and osteoporosis. Is this considered a screening, and what V code would we use for the diagnosis?

Codify Member

Answer: The answer depends on whether the order is saying "screening to rule out osteoporosis/osteopenia" or whether it's saying the patient has already been diagnosed with those, which would mean the test is no longer considered a screening.

Screening: If the physician ordered the exam before a diagnosis was made, you should consider this a screening. Report the DXA (for example, 77080, Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) and the screening diagnosis (V82.81, Special screening for osteoporosis). If there's a confirmed finding (such as osteopenia, 733.90, Disorder of bone and cartilage, unspecified), you should report the code for the finding as a secondary diagnosis.

Not a screening: This is not a screening if the ordering physician ordered the DXA scan because the patient had a previous DXA that showed osteopenia or osteoporosis. As a result coverage could be an issue. If the patient had a previous osteopenia diagnosis, check to see whether the test was to monitor drug therapy. According to Medicare Claims Processing Manual, Chapter 13, Section 140 (www.cms.gov/manuals/downloads/clm104c13.pdf), carriers cover DXA tests every two years when used to monitor FDA-approved osteoporosis drug therapy.

Review the manual to get a view of national policies and then check your local payer policies for specific diagnosis code requirements.