Nancy Posted Tue 14th of February, 2012 20:04:06 PM
Patient presents to office for screening dexa bone density test but RX from her doctor states osteopenia and osteoporosis. Is this considered a screening and what V code would we use for diagnosis.??
Ldy Answered Tue 14th of February, 2012 20:27:04 PM
SuperCoder Answered Tue 14th of February, 2012 22:41:33 PM
Just to add to that, I wonder if the order is saying “screening to rule out osteoporosis/osteopenia” or if it’s saying the patient has already been diagnosed with those, which would mean it’s no longer considered a screening. I found the Reader Question below from a 2010 Radiology Coding Alert. The transmittal it mentions is part of Medicare Claims Processing Manual, Chapter 13, section 140 (http://www.cms.gov/manuals/downloads/clm104c13.pdf). It goes into which dx CMS covers for screening and monitoring during drug therapy (discusses national codes and when you need to verify additional codes with the local payer).
Here’s the Reader Question:
Dig Into DXA for Osteopenia
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?
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).
Deborah Marsh, JD, MA, CPC, CHONC
The Coding Institute