Radiology Coding Alert

Question: Which CPT and ICD-9 codes should I report for an axial DXA scan for a patient with postmenopausal osteoporosis?

Oregon Subscriber

Answer: You should report 77080 (Dual-energy x-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) and 733.01 (Senile osteoporosis).

Good news: Medicare covers 77080 when (1) the physician uses that DXA service to monitor osteoporosis drug therapy and (2) you report 77080 with an appropriate diagnosis code.

Examples of covered diagnoses include these:

•  255.0 -- Cushing's syndrome
•  733.00 -- Osteoporosis, unspecified
•  733.01 -- Senile osteoporosis
•  733.02 -- Idiopathic osteoporosis
•  733.03 -- Disuse osteoporosis
•  733.09 -- Osteoporosis; other
•  733.90 -- Disorder of bone and cartilage, unspecified.

Note: Medicare doesn't cover bone mass measurement to monitor osteoporosis drug therapy using other procedures.

Result: Medicare won't pay if you report the above ICD-9 codes with these CPT codes:

• 76977 -- Ultrasound bone density measurement and interpretation, peripheral site(s), any method
• 77078 -- Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
• 77079 -- ... appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
• 77081 -- Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
• 77083 -- Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), 1 or more sites
• G0130 -- Single-energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel).

Caution: Don't base your coding on what the payer will cover. Only report those codes the physician's documentation supports.

Resource: Check out MLN Matters article MM5521, "Bone Mass Measurements (BMMs)," at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5521.pdf.