Oncology & Hematology Coding Alert

Question: Our center provides DXA screenings for certain cancer patients. We've been getting denials from Medicare on those claims where we report both 77080 and 77081. Do we need to add a modifier to one of the codes?

Answer: Whether you may report both studies together will depend on your payer. CMS has a mutually exclusive edit that places 77081 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; appendicular skeleton [peripheral] [e.g., radius, wrist, heel]) in column 1 and 77080 (... axial skeleton [e.g., hips, pelvis, spine]) in column 2. This edit has a modifier indicator of 1.

Chapter 9, section H.14, of the National Correct Coding Initiative Policy Manual states, "Although it may be medically reasonable and necessary to report both axial and peripheral bone density studies on the same date of service, NCCI edits prevent the reporting of multiple CPT codes for the axial bone density study or multiple CPT codes for the peripheral site bone density study on the same date of service."

Experts indicate this means that you should be able to append modifier 59 (Distinct procedural service) to override the edit when you meet the "reasonable and necessary" criteria.

Snag: You will need to check your payer's policy on when it considers 77080 and 77081 performed on the same date to be reasonable and necessary.

For example, WPS Medicare states, "Medicare will not reimburse for both axial and appendicular testing on the same date of service or within 30 days of each other, unless the medical records substantiate that the BMM initially obtained was unreadable. Conditions that verify to Medicare that a BMM is unreadable and a second BMM is medically necessary include documentation the patient has artificial instrumentation in place in either hip or spine, or other conditions that preclude a reading in those locations" (www.wpsmedicare.com/part_b/policy/active/local/_files/l28527_ms004.pdf).

If you meet the requirements for medical necessity for the second study, report 77081 and append modifier 59 to 77080.

Learn more: You can find additional information on Medicare's bone mass measurement requirements here:

• Medicare Benefit Policy Manual, chapter 15, section 80.5
• Medicare Claims Processing Manual, chapter 13, section 140.

Manuals are available online at www.cms.gov/Manuals/.