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.