Radiology Coding Alert

Question: I’m having trouble determining which specific code to use for a bone density study. Can you explain the differences between the different DXA codes in the 77080-77086 code range?

Texas Subscriber

Answer: You will find four codes in the CPT^® manual that pertain to dual-energy X-ray absorptiometry (DEXA or DXA) bone and joint studies. Code 77080 (Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)) includes scanning the patient’s hip, pelvis, or lower spine region. Code 77081 (…; appendicular skeleton (peripheral) (eg, radius, wrist, heel)) is for studies of peripheral areas, such as the radius, wrist, or heel. If the radiologist performs an axial skeleton scan and an evaluation of a spinal fracture, then you’ll use 77085 (…; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment). However, if the radiologist only assessed a vertebral fracture, you’ll use 77086 (Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)) to code the report.

The documentation should include information about where the physician performed the procedure. If the documentation includes wording such as “lumbar spine,” “L1-L5 vertebrae,” or “thoracic spine,” you’ll be able to conclude a vertebral fracture assessment was performed.

Billing note: Codes 77085 and 77086 can be billed only once, even if the radiologist performs the procedure on multiple vertebral segments.