Wiki 77080 & 77081 NCCI edits?

mcdream

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Anyone familiar with coding dexa scans? Are there any NCCI edits for billing both 77080 & 77081 together when both are done same encounter (same date of service)?
How are you billing- sequencing? modifier?
Any advice &/or reference would be greatly appreciated.
Thanks!
 
77080 and 77081 NCCI

Chapter 9, section H.14, 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 multiple CPT codes for the axial bone density study or multiple CPT codes for the peripheral site bone density study on the same date of service."

Experts indicate this means that you should be able to append modifier 59 (Distinct procedural service) to override the edit when you meet the "reasonable and necessary" criteria.

Snag: You will need to check your payer's policy on when it considers 77080 and 77081 performed on the same date to be reasonable and necessary.

For example, WPS Medicare states, "Medicare will not reimburse for both axial and appendicular testing on the same date of service or within 30 days of each other, unless the medical records substantiate that the BMM initially obtained was unreadable. Conditions that verify to Medicare that a BMM is unreadable and a second BMM is medically necessary include documentation the patient has artificial instrumentation in place in either hip or spine, or other conditions that preclude a reading in those locations"
 
Chapter 9, section H.14, 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 multiple CPT codes for the axial bone density study or multiple CPT codes for the peripheral site bone density study on the same date of service."

Experts indicate this means that you should be able to append modifier 59 (Distinct procedural service) to override the edit when you meet the "reasonable and necessary" criteria.

Snag: You will need to check your payer's policy on when it considers 77080 and 77081 performed on the same date to be reasonable and necessary.

For example, WPS Medicare states, "Medicare will not reimburse for both axial and appendicular testing on the same date of service or within 30 days of each other, unless the medical records substantiate that the BMM initially obtained was unreadable. Conditions that verify to Medicare that a BMM is unreadable and a second BMM is medically necessary include documentation the patient has artificial instrumentation in place in either hip or spine, or other conditions that preclude a reading in those locations"

Great info! Thank you!
Breaking the NCCI edit down...

The first part is clear "although it may be medically reasonable and necessary to report BOTH axial AND peripheral bone density studies on the same date of service"

The second part is a bit unclear to me "NCCI edits prevent the reporting of MULTIPLE CPT codes FOR the axial OR MULTIPLE CPT codes FOR the peripheral on the same date of service"...clearly you would never bill 77080 more than once (multiple) per date of service (as the code description states axial of 1 or more sites) same goes for 77081 (peripheral of 1or more sites).
So is this edit to be interpreted as: if both 77080 & 77081 we're performed on the same date of service then bill 77080 (axial) ONCE WITH 77081 (peripheral) ONCE with modifier 59 appended?

Thanks!
 
Last edited:
Coding Data Analyst, CPC

Great info! Thank you!
Breaking the NCCI edit down...

The first part is clear "although it may be medically reasonable and necessary to report BOTH axial AND peripheral bone density studies on the same date of service"

The second part is a bit unclear to me "NCCI edits prevent the reporting of MULTIPLE CPT codes FOR the axial OR MULTIPLE CPT codes FOR the peripheral on the same date of service"...clearly you would never bill 77080 more than once (multiple) per date of service (as the code description states axial of 1 or more sites) same goes for 77081 (peripheral of 1or more sites).
So is this edit to be interpreted as: if both 77080 & 77081 we're performed on the same date of service then bill 77080 (axial) ONCE WITH 77081 (peripheral) ONCE with modifier 59 appended?

Thanks!

If both are done at the same session, bill 77080 only.
 
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