Proper Reporting for Bone Mass Measurement
A physician may order a bone mass measurement (BMM) study to identify bone mass, detect bone loss, or determine bone quality in a patient. BMM is performed with either a bone densitometer (other than single-photon or dual-photon absorptiometry) or a bone sonometer system.
Medicare covers screening BMM once every two years (or more, if medically necessary) under the following conditions (Medicare Benefit Policy Manual, ch.15 §80.5.4):
- Is ordered by the physician or qualified nonphysician practitioner who is treating the beneficiary following an evaluation of the need for a BMM and determination of the appropriate BMM to be used.
- Is performed under the appropriate level of physician supervision as defined in 42 CFR 410.32(b).
- Is reasonable and necessary for diagnosing and treating the condition of a beneficiary who meets the conditions described in §80.5.6.
- In the case of an individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy, is performed with a dual-energy X-ray absorptiometry system (axial skeleton).
Coding for BMM
BMM claims for dual-energy X-ray absorptiometry (CPT® 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) are reimbursable when this procedure is used to monitor osteoporosis drug therapy.
A physician’s interpretation of the BMM results and a valid diagnosis code (e.g., M85.8- Other specified disorders of bone density and structure) must also be reported, indicating the reason for the test is for a postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.
New Guidelines for 2016
Note that the Centers for Medicare & Medicaid Services (CMS) implemented Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. This CR establishes the list of covered conditions and corresponding ICD-10-CM diagnosis codes approved for BMM studies according to the National Coverage Determination (NCD) 150.3. However, CR9252 and the accompanying spreadsheet inadvertently omitted the condition of osteopenia and the ICD-10-CM codes that describe it, which are classified to subcategory M85.8-.
Medicare Benefit Policy Manual: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
Medicare Coverage Database, NCD 150.3: www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=256&ncdver=2&DocID=150.3&SearchType=Advanced&bc=IAAAABAAAAAA&
MLN Matters Article SE1525: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1525.pdf