Radiology Coding Alert

Question: If a patient has had DXA exams(77080) for years for osteopenia, is the exam still considered a routine screening test? The patient says the DXA scan is a screening exam and covered 100 percent. Does the DXA scan qualify as a screening exam?

Tennessee Subscriber

Answer: This is not a screening if the ordering physician ordered the DXA scan (77080, Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) because the patient had a previous DXA that showed osteopenia, which is lower than normal bone density that is not yet osteoporosis.

However, if the physician ordered the exam before a diagnosis was made and the result shows osteopenia (733.90, Disorder of bone and cartilage, unspecified), then this current exam is still a screening exam. You should report the screening diagnosis (V82.81, Special screening for other conditions; osteoporosis) as the primary, followed by the finding.

Smart move: If the patient had a previous osteopenia diagnosis, 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]) when coded with 733.0x (Osteoporosis), 733.90 which includes osteopenia, or 255.0 (Cushing's syndrome).

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