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Medicare Compliance & Reimbursement

Reader Questions:

Simplify DEXA Screening Issues

Published on Tue Nov 23, 2010

Question: If a patient has had DEXA exams for years and our doctor treated her for osteopenia, is this still considered a routine screening test? My colleague billed it with an osteopenia diagnosis and the payer applied this visit to the deductible. The patient says the DEXA scan is a screening exam and covered 100 percent. Does the DEXA scan qualify as a screening exam? Answer: If the reason the doctor performed the DEXA scan (77080, Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) was because the patient had a previous DEXA that showed osteopenia, it is not a screening exam. However, if the doctor ordered it before a diagnosis was made and the result shows osteopenia (733.90, Disorder of bone and cartilage, unspecified), then this is still a screening exam and the screening diagnosis (V82.81, Special screening for other conditions; [...]
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