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 which Z code would we use for the diagnosis?

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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 (Z13.820, Encounter for screening for osteoporosis).

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. If, however, the patient has a confirmed diagnosis such as osteopenia and the doctor performs the scan for a medically necessary reason (for instance, he’s monitoring drug effectiveness), you should report the code for the diagnosed condition, such as M85.89 (Other specified disorders of bone density and structure, multiple sites).