Radiology Coding Alert

Watch out: A denial for this old code could cost you $100 a pop If you find tracking Medicare’s DXA claim restrictions on medical necessity and frequency a real chore, join the club. But you can simplify the process and reduce denials by following this expert advice on keeping DXA claims airtight.
1. Confirm That Your Superbill Carries 2007 DXA Codes For measuring bone density, DXA is the gold standard, says experienced radiology coder Donna J. Richmond, BA, CPC, RCC, quality assurance supervisor with CodeRyte, in The Coding Institute audioconference “Surefire Bone Density Screening Strategies.” Pay attention: CPT 2007 changed the code numbers -- but not the descriptors -- for DXA.
  Example: A physician orders an axial skeleton DXA for an estrogen-deficient female patient at risk for osteoporosis. You report 77080 for services performed on or after Jan. 1, 2007. Rationale for change: Regrouping codes into different parts of CPT 2007 gives them a more logical location in the CPT manual, says Annette Grady, CPC, CPC-H, CPC-P, an independent coding consultant in North Dakota and member of the AAPC National Advisory Board.

If you’re confused about all of the crosswalked codes, Grady recommends that you check out CPT 2007 Appendix M. This “Crosswalk to Deleted CPT Codes” contains a list of all the crosswalked codes for this year. Remember: Using the updated codes will save you from payment delays you don’t need, considering Medicare pays roughly $100 for global 77080.


2. Get Up to Snuff on National and Local Rules Documentation tip: Your documentation needs to include an order from a physician or qualified non-physician practitioner and an interpretation of the test results (Medicare Carriers Manual, Part 3, Section 4181.1). Signing the machine print-out doesn’t count as an interpretation, Richmond says. The physician also needs to document a complete diagnosis. Medicare doesn’t offer a national list of covered ICD-9 codes, but it does state that an individual qualified for coverage will meet one of these conditions: 1. is estrogen-deficient and at risk for osteoporosis (female only) 2. has been diagnosed by x-ray with osteoporosis, osteopenia, or vertebral fracture 3. is receiving glucocorticoid therapy greater than or equal to 7.5 mg of prednisone per day for more than three months 4. has primary hyperparathyroidism 5. is being monitored for FDA-approved osteoporosis drug efficacy.   Check your payer’s LCD for the specific ICD-9 codes it says support medical necessity. Example: National Government Services (formerly Empire Medicare) lists diagnoses that may prove medical necessity, such as 252.01 (Primary hyperparathyroidism) and 733.12 (Pathologic fracture of distal radius and ulna). The LCD also gives notes with certain ICD-9 codes, such as “ICD-9-CM code [...]