Bone Density

cmac

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i work for a family physician and am having a difficult time with the new LCD for Bone Density's and everytime you call Medicare you get a different answer. Does anyone have experience billing Bone Density? They will pay every 2 yrs unless they meet the under 2 yrs requirements. It does list dx that will be paid however it's a bit misleading. For instance it states something along the lines of 733.00 will be denied if not used with the screening dx. Well the screening dx for osteoporosis is V82.81 - would it be correct to use V82.81 and 733.00? Does anyone know any helpful hints, websites regarding this? Any suggestions would do. Thanks
 

desiree384

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For 77080 - DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE),
733.00 is payable by itself with GHI Medicare in NY. I'm not sure which Medicare carrier you are billing for. You can check the CMS website for the LCD for that carrier for bone density and see its coding information.
http://www.cms.hhs.gov/mcd/results.asp?show=all&t=2008427183923
 

bkreed

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Dear c,

I work for an endocrinologist and bill bone density by dexa nearly every day. Medicare (Palmetto GBA in Ohio) will pay 77080 every two years. Our problem has been getting private payers to pay 77082 which is a lateral view of the spine by dexa to assess vertebral fracture. Cigna, Aetna, and BCBS deem 77082 experimental/investigational. Medicare, by LCD not national, will pay for VFA, 77082. Our physician has addressed this issue with the medical directors of those insurances but without success, yet! Check LCD at Medicare's website, www.cms.org. Filter your search by your carrier. Dx's will be listed also. We use 733.00 osteoporosis; 627.2 menopausal state; 781.91 loss of height; and 995.20 adverse effect of drug as dx's.

Good luck with your bone density billing!
bkreed
 
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The issue our clinic is running into is our patients who are getting them done for screenings. As of this year, V82.81 cannot be billed to Medicare by itself. The book states to also bill V49.81 - Asymptomatic postmenopausal status (age-related) (natural)

Our Providers feel that this should not be billed with every patient because they may not be Asymptomatic postmenopausal.

Has anyone run into this issue yet?
 

mitchellde

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The issue our clinic is running into is our patients who are getting them done for screenings. As of this year, V82.81 cannot be billed to Medicare by itself. The book states to also bill V49.81 - Asymptomatic postmenopausal status (age-related) (natural)

Our Providers feel that this should not be billed with every patient because they may not be Asymptomatic postmenopausal.

Has anyone run into this issue yet?
If the reason for the test is screening the you must use the screening code first listed. If there is no finding then the screening code will be the only dx code. If the payer does not pay this due to timing or medical necessity then you will need to bill the patient. You absolutely cannot assign a dx code for a dx the patient does not have!
 
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