pookergirl
Networker
Looking for some input on this: We frequently code BMD/DEXAs in my department and we have a training guide stating we should use Z13.820 screening for osteoporosis for the admit and principal diagnosis and then add any findings as secondary in the final. I was dinged on my QA audit last month because the order diagnosis had both screening for osteoporosis and M81.6 localized osteoporosis, unspecified pathological fracture presence listed as a diagnosis on the order. On the indication for study by the radiologist or radiologist tech it stated postmenopausal osteoporosis screening and the findings were osteopenia. Full disclosure, almost all of the radiologist DEXA reports have "postmenopausal osteoporosis screening" whether or not the order says "breast cancer," 'osteoporosis" or any other sign or symptom, most times the actual DEXA report will just say "postmenopausal osteoporosis screening." I chose to use the osteoporosis and the menopause Z78.0 for the admit and I used the osteopenia, R/L thigh and menopause for the final and left the screening off since the order had a diagnosis of osteoporosis on it. I was told this was wrong and my manager and supervisor met with me and my manager said not to use the osteoporosis code at all, only use the screening as admit and principal and then code the R/L osteopenia thighs and the Z78.0 code as secondary. Was this right? I feel like this is completely incorrect coding. We don't have the luxury of querying the provider as this is an ancillary department for a large healthcare organization and it's just not always possible. I re-read our training guide and it does state to always use Z13.820 as admit and final on ALL DEXAs. When I sent them links from CMS that showed Z13.820 wasn't even listed as a payable diagnosis they said they've had no issues with CMS not paying for Z13.820. There's a wiki about DEXAs on AAPCs website but unfortunately the bottom line reads "According to Medicare National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM), Z13.820 Encounter for screening for osteoporosis is not covered by Medicare for a diagnostic lab testing service." I personally interpreted this to mean Z13.820 isn't covering DEXAs but my supervisor pointed out in red "....for a diagnostic LAB testing service" stating that we are not talking about labs here we are talking about imaging. Tonight I coded another DEXA and patient has a history of breast cancer on Arimdex and that is all that is on the order and miraculously it's on the DEXA scan and not postmenopausal screening for osteo - and now I'm second guessing myself completely. I guess I have to follow our training guide and use screening for that too?
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