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Radiology Coding Alert

READER QUESTIONS:

Prove 77080/77081 Necessity or Else

Published on Mon May 11, 2009

Question: Our Medicare contractor has been denying 77080 as not paid as separate procedure and not a medical necessity when billed with 77081, even if the patients last DXA was more than 24 months ago. The diagnosis codes we use are 733.01, 733.02, 733.09, and V49.81. Should we use a modifier on the claim to stopgetting these denials? Illinois Subscriber Answer: 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 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 [...]
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