Ob-Gyn Coding Alert

Question: The September 1998 Ob-Gyn Coding Alert discusses how Medicare Now Covers Bone Mass Measurements to screen women for signs of osteoporosis. Medicare Bulletin #163, February 1998, states screening for osteoporosis is denied by statute. Our question is in regards to the female patient who is otherwise asymptomatic however, demonstrated a loss in height since her last height measurement, indicating possible bone loss. Would the ICD-9 code 733.02, idiopathic osteoporosis (bone mass reduction usually without abnormality of mineral or organic content) be appropriate in this situation for coding the BMD Scan (76076, dx 733.02)?

Trudy A. Brody, Business Office Supervisor
Ob/Gyn Health Center, Medford, OR

Answer: As the September 1998, article stated, Medicare began covering bone mass measurement under new rules effective July 1, 1998. Since the Bulletin you refer to was published prior to this date, it is no longer effective. Prior to this date, only single photon absorptiometry was covered by Medicare, but only when the physician was assessing changes in bone density of patients with osteodystrophy when performed at intervals of 6 to 12 months. Medicare does not list loss of height as among the reasons they would cover, but it might loosely qualify as an indicator of a problem in an estrogen-deficient woman (the rules state this assessment must be based on medical history or other findings). However, the codes from category 733 can only be reported when osteoporosis has been confirmed, not suspected. There is no code for suspected bone loss, but there is a code for musculoskeletal symptoms, 781.9, and for screening of other conditions, V82.8.