Wiki Dexa 77080 & 77081

[AForeman]

Is it appropiate to bill for both 77080 and 77081 together the same day? Patient had bone denity of both the foremarm and the hip. I have been billing w/ both of these codes and I do use a 59 modifier on 77080 but lately they are being denied. I can't find anything that says I can't bill for them together except last week I received a notice from Medlearn saying that are NCI edits against coding both of these together. Any advice would be greatly appreciated. Thanks!

 

[ajs]

Is it appropiate to bill for both 77080 and 77081 together the same day? Patient had bone denity of both the foremarm and the hip. I have been billing w/ both of these codes and I do use a 59 modifier on 77080 but lately they are being denied. I can't find anything that says I can't bill for them together except last week I received a notice from Medlearn saying that are NCI edits against coding both of these together. Any advice would be greatly appreciated. Thanks!

CCI edits still allow them billed at the same time with a modifier 59. I would code the 77080 primary as it has higher RVUs and the 77081-59 as secondary. That may be why the denial is coming thru.

 

[donnajrichmond]

No you cannot code both. Clinical Examples in Radiology, jointly published by AMA and ACR, Summer 2007 says that it is not appropriate to code both. 77080 was valued to include 77081 when both are performed.
NCCI Policy Manual, Chapter 9 says "14. Axial bone density studies may be reported with CPT codes 77078 or 77080. Peripheral site bone density studies may be reported with CPT codes 77081, 76977, or G0130. 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."

 

[AForeman]

i was able to get an answer from president of chapter. She said that I can not bill for both. 77081 is in indented text and the primary cpt 77080 reads 1 or more sites, therefore if pt has exam performed of appendicular skeleton I can only bill for 77081.

 

[klcampbe]

I take the comment from the NCCI manual:
"Although it may be medically reasonable and necessary to report both axial and peripheral bone density studies on the same date of service" to mean that when both axial and appendicular studies are done, both may be reported.

 

[TeresaLambert]

Rhit, cpc

I took the "one or more sites" to mean one or more sites of the axial skeleton (hips, pelivs, spine) for 77080 and "one or more sites" for the appendicular skeleton (radius, wrist, heel) 77081 not one or more sites from different areas.