Radiology Coding Alert

Question: Our physician does bone density assessment with DEXA. How can we report this procedure? Also, the patient had the last bone density assessment done almost a year ago? Is there a frequency or window period for reporting bone density assessments?

Alaska Subscriber

Answer: For bone density tests, you first need to confirm the site of assessments. When your physician does bone density or bone mass assessments using DEXA, you have the following codes to choose from:

• 77080 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine), 

• 77081 (... appendicular skeleton [peripheral] [e.g., radius, wrist, heel]), or

• 77086 (Vertebral fracture assessment via dual-energy X-ray absorptiometry [DXA]) 

A DEXA scan measures the density of bones in the spine and often one or both hips. It’s more sensitive and accurate than the CT at measuring small changes in bone density over time or in response to drug therapy.

Ensure you’re within the timeframe of 2 years: Turn to the calendar for your final checkpoint for successful bone density claims. Medicare will pay for bone mass measurements on qualified individuals every two years. “Every two years” means “at least 23 months have passed since the month” of the last bone mass measurement (Medicare Carriers Manual, Part 3, Section 4181.2).

Document medical necessity: If you can document medical necessity on the patient, Medicare will allow you to bill within the two-year window, but it must be medically necessary. Otherwise, the two-year rule for all “healthy” individuals is a good guideline to follow.

Two examples of when earlier tests might be necessary include:

• Monitoring a patient who’s been on glucocorticoid therapy for more than three months

• Needing a baseline measurement to monitor a patient who had an initial test using a different technique than the one your physician wants to use for monitoring her (such as sonometry versus densitometry).