77080- Rejected due to patients age?

[cris722]

I have a recurring problem with billing DEXA scans.

I have a 64 year old female patient whom was sent to our office for a DEXA scan with diagnosis code Z13.820. It was rejected by Humana Medicare stating the procedure code is inconsistent with the patient's age?

I would appreciate any advice.

Thank you

 

[Tjb0817@gmail.com]

If 77080 is an age-specific CPT code, then verify correct DOB on claim, or if recurring denial reason, then verify payer has correct age and DOB. So correct and resubmit. If not,
Medicare Part B covers DEXA scans (bone mass measurement) once every 24 months for people who are at risk for osteoporosis AND meet one or more of the following conditions:

• A woman whose doctor determines, based on her medical history and other findings, that she is estrogen deficient and at risk for osteoporosis.
• A patient whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
• A patient taking prednisone or steroid-type drugs, or who is planning to begin this treatment. Z79.51-2
• A patient diagnosed with primary hyperparathyroidism.
• A patient being monitored to see if their osteoporosis drug therapy is working. Z79.83

Both screening code and the risk factor code must be provided. Claims for “Screening DXA Bone Density, Z13820” without any other indication will be denied.

ICD-10 CM code Z90.721 or Z90.722 should be reported for women s/p oophorectomy. ICD-10 CM code Z79.51, Z79.52 should be reported for an individual on glucocorticoid therapy. ICD-10 CM code Z79.83 should be reported for DXA testing while taking medicines for osteoporosis/osteopenia.--