Wiki Celiac Disease and DEXA

[TMikke83]

One of the docs I code for ordered a DEXA (77080) for a patient with Celiac Disease (K90.0). Radiology is telling him they won't use the Celiac code because it won't be paid. The links between Osteoporosis and digestive diseases exists, but getting those codes paid is another story. Does anyone have any other information on this? I have tried searching the LCD's/NCD's, and I can't find much of anything. My boss isn't here for me to ask, but she is the one who told me Celiac Disease is payable for a DEXA. Any advice is appreciated, thank you!

 

[mitchellde]

The problem is, if the provider orders the DEXA for the diagnosis of Celiac disease then that is what must be coded, whether it is what the payer recognizes as medical necessity or not. If the claim is denied for medical necessity then you will need to appeal the decision with supporting medical literature to show this is necessary.

 

[TMikke83]

The problem is, if the provider orders the DEXA for the diagnosis of Celiac disease then that is what must be coded, whether it is what the payer recognizes as medical necessity or not. If the claim is denied for medical necessity then you will need to appeal the decision with supporting medical literature to show this is necessary.

The patient has Celiac Disease, that has been established. The DEXA is to check the bone density, because patients with GI disease can have bone loss due to malabsorption. I wasn't sure if he needed to add a screening code to the order or just keep the K90.0. Thanks!