Breaking Bad Osteoporosis Coding

Breaking Bad Osteoporosis Coding

By Renee Dustman

Two million broken bones occur every year in the United States due to osteoporosis, according to the National Osteoporosis Foundation (NOF).

Osteoporosis is a disease that makes a person’s bones weak and more likely to break. The NOF reports that approximately 9 million Americans have osteoporosis and another 43 million have low bone density, placing them at increased risk.

BMM is a Preventive Service

Medicare provides coverage of, and payment for, bone mass measurement (BMM) screening to identify bone mass, detect bone loss, or determine bone quality once every two years (more often, if medically necessary).

Because BMM screening is a preventive service, the copayment/coinsurance and deductible are waived.

Procedure Codes Reflect New Technology

Single and dual photon absorptiometry are no longer used and, as such, CPT® codes 78350 and 78351 have been deleted for 2015 reporting.

CPT® bone mass procedure codes payable under Medicare are:

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 (eg, hips, pelvis, spine)

77080    Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)

77081    Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

77085    Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment

77086    Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)

G0130    Single energy X-ray absorptiometry (Sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

Payment Hinges On Diagnosis and Medical Necessity

For a BMM study to be covered, a patient must meet at least one of five conditions: estrogen-deficient, vertebral abnormality, steroid treatment, hyperparathyroidism, osteoporosis drug therapy monitoring.

ICD-9-CM diagnosis coding is dependent on the procedure being reported. For example, ICD-9-CM codes that support 77080 include 733.0, 733.01, 733.02, 733.03, 733.09, 733.90, V58.65, V58.68, V58.69, and 255.0. For the remaining procedure codes listed above, acceptable diagnoses include: 252.01, 256.2, 256.31, 627.1, 627.2, 627.3, 627.4, 627.8, 733.13, 805,00-805.7, 806.00-806.79, V49.81, V58.65, and V58.69.

2017-code-book-bundles-728x90-01

Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

Leave a Reply

Your email address will not be published. Required fields are marked *