Radiology Coding Alert

Question: We’ve been getting referrals from family doctors for screenings following the Welcome to Medicare (WTM) exam. Should we code these differently than a usual screening?


Washington Subscriber


Answer: If your radiologist provides screenings ordered by a physician following the WTM exam, you need to report the appropriate CPT Codes and ICD-9 Codes the same as you would for a usual screening.

During the WTM exam, the primary provider may recommend a number of screenings for the patient--many of which Medicare now covers. These screenings are not part of the WTM exam; Medicare covers them separately if the physician orders them. Your radiologist is most likely to see bone mass measurement (76075, Dual-energy x-ray absorptiometry [DXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) and screening mammography (76092, Screening mammography, bilateral [two-view film study of each breast]).
 
Report an appropriate ICD-9 code such as V82.81 (Special screening for osteoporosis) and V49.81 (Asymptomatic postmenopausal status [age-related] [natural]) for the bone screening. Or if the patient has a qualifying condition, such as osteoporosis (733.0x), report that condition rather than the screening code.

For the screening mammography, choose between V76.11 (Screening mammogram for high-risk patient) and V76.12 (Other screening mammogram).
 
Warning: Check the screening tests’ frequency limits. Bone mass measurement may only be done every 24 months for qualified individuals (more often if medically necessary). You may offer screening mammograms annually for women over age 39.