Radiology Coding Alert

Question: Which ICD-9 code should I report for a 64-year-old female patient with a history of osteopenia? The DXA report also shows osteopenia.

North Carolina Subscriber

Answer: The ICD-9 manual index points you to 733.90 (Disorder of bone and cartilage, unspecified) for osteopenia, which is lower than normal bone density that is not yet osteoporosis.

Because the patient has a history of osteopenia, this DXA is not a screening.

Check to see whether the test was to monitor drug therapy. According to CMS transmittal 1416, carriers cover DXA tests used to monitor FDA-approved osteoporosis drug therapy every two years. But coverage applies only for 77080 (Dual-energy x-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) coded with 733.0X (Osteoporosis), 733.90, or 255.0 (Cushing's syndrome).

Resource: Find more on DXA coverage in CMS transmittal 1416 (www.cms.hhs.gov/transmittals/downloads/R1416CP.pdf).

Bonus tip: ICD-9 2009, effective Oct. 1, adds the entry "borderline osteopenia," also coded as 733.90.