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Orthopedic Coding Alert

Reader Questions:

Payers May Sway on DEXA Limits

Published on Fri Sep 10, 2004

Question: If we perform a DEXA scan on a patient, and then repeat the DEXA a year later to assess treatment effectiveness, how should we report the second DEXA scan?

New Jersey Subscriber

Answer: CPT does not include a separate code to report follow-up dual energy x-ray absorptiometry (DEXA) scans. Therefore, you should report the appropriate code depending on whether you assessed the axial skeleton (76075, Dual energy x-ray absorptiometry [DEXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) or appendicular skeleton (76076, ... appendicular skeleton [peripheral] [e.g., radius, wrist, heel]).
 
If you perform the DEXA scan on a Medicare patient, you should ask your carrier whether it imposes frequency limits on the procedure. Empire Medicare (a Part B payer in New Jersey), for example, covers bone mass measurements once every two years for most patients. But if your patient meets certain requirements, Empire may pay for a bone mass measurement "after 11 months have elapsed since the previous bone mass measurement test."
 
To qualify for the 11-month frequency guideline, the orthopedist must use the second DEXA scan for one of three reasons:

 

  • to monitor beneficiaries on long-term glucocorticoid (steroid) therapy of more than three months (patients must be on glucocorticoids for more than three months, but BMM monitoring is done yearly).
     
  • to monitor beneficiaries on FDA-approved osteoporosis drug therapy until test results have stabilized.
     
  • to assess the response and efficacy of therapy until a response to such therapy has been documented over time.

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