Radiology Coding Alert

Question: Under what circumstances will Medicare cover 77078 for monitoring patients on osteoporosis drug therapy?

Rhode Island Subscriber

Answer: Doubling up on appropriate diagnoses is the key to Medicare coverage of 77078 (Computed tomography, bone mineral density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]), according to recent CMS transmittal 1416 (http://www.cms.hhs.gov/transmittals/downloads/R1416CP.pdf), effective Feb. 20.

You should report a code from the 733.0x series (Osteoporosis), 733.90 (Disorder of bone and cartilage, unspecified) or 255.0 (Cushing's syndrome).

But you must also have a valid ICD-9 code from the list your local contractor maintains to indicate the reason a physician ordered the screening: postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.

Remember: You should choose the appropriate code based on the radiologist's documentation.

The above rule on double diagnoses applies if you report any of the following codes to Medicare for monitoring patients on osteoporosis drugs:

• 76977 -- Ultrasound bone density measurement and interpretation, peripheral site(s), any method

• 77079 -- Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

• 77081 -- Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

• 77083 -- Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), 1 or more sites

• G0130 -- Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel).

Tip: The drugs must be FDA-approved, and Medicare's two-year frequency standard limits coverage.

Don't miss: If you report 77080 (Dual-energy x-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]), Medicare will cover the test without the additional code from your local contractor. Codes 733.0x, 733.90 and 255.0 each earn coverage for this test.