Wiki Cpt 77080 & 77082

[coding4fun]

Recieved a denial for billing these codes together. No modifier was used for billing. I am a little confused regarding billing these two services. Could you gu yt? S please enlighten me regarding billing together & if modifier is needed. Thanks for your help!

 

[OCD_coder]

Just a thought here...but it is curious that you billed for a spine DEXA scan 77080 and an assessment for verterbral fractures 77082, a review of the documentation would be in order to determine that two separate services were performed.

 

[coding4fun]

I am not familiar with RAD billing but isnt the dexa scan (77080) included in the billing of cpt (77082)? Would you use a modifier for clarification?

 

[StephanieWestfall]

I am also receiving denials for 77080 and 77082 billed together without a modifier, but only from Aetna. The denial reason is that it hasn't been proven to be effective.

I contacted Aetna and was told they generally deny this code but we could try to obtain a prior authorization for future patients. I was also told that we could try to appeal the denials with proof of medical necessity.

Also, 77081 is included with 77080 and cannot be billed separately.