Radiology Coding Alert

Question: Our carrier denied G0131 (Computerized tomography bone mineral density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) for a CT bone density test that we performed. Is there a more appropriate code for this service?

Answer: HCPCS deleted G0131 effective Jan. 1, 2003, and refers coders to use code 76070 (Computed tomography, bone mineral density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) for these services instead.

If you perform a bone density CT study of the appendicular skeleton, you should report 76071 (... appendicular skeleton [peripheral] [e.g., radius, wrist, heel]) because HCPCS deleted G0132 (Computerized tomography bone mineral density study, one or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]) in 2003 as well.

Most carriers will not reimburse you for both an axial and appendicular CT bone density study on the  same day. For example, the TrailBlazer Health Enterprises (the Part B carrier for Virginia) local medical review policy states, "If the spine and heel are studied, either code 76070 or 76071 should be billed once, but not both codes."

However, there may be clinical conditions and followup of certain therapies that demand both axial and peripheral studies.

In such cases, the patient should be advised of potential non-coverage and should sign an advance beneficiary notice (ABN) so that if the insurer denies the claim for one or both studies, you may then bill the patient directly.