Wiki Dexa Scan (77080) Dx Denials

[mrosbun]

I am a coder in KY and have started getting @ mid February, medical necessity denials from Medicare when billing my dexa scans. We perform & read the scan. I have used v45.77 (total hysterectomy) as my Dx. This used to pay. I have looked under the LCD's & NCD's and am assuming that it is no longer payable.

Any recomendations?

Dexafused

 

[mitchellde]

What is the reason for the scan, hysterectomy status is not a medical necessity for a dexa scan

 

[mrosbun]

Dexascan

Hold on and wait for this....The dr gave the dx 401.9 (hypertension). Which I know that I cannot use. The hysterectomy was the only thing close that I could come up with. There isn't anything else

Dexafused

 

[mitchellde]

Why did he order the dexa? If it was for screening then you will need to use screening v code and it will be patient responsibility

 

[marymessina1998@yahoo.com]

Most of the LCD'S for the dexa scans have to have dx codes such as osteoporisis, or osteopenia, or menopausal condtions.. I have never seen hypertension on the LCD. The codes are pretty limited to what is covered.

 

[balamuruganm]

Hold on and wait for this....The dr gave the dx 401.9 (hypertension). Which I know that I cannot use. The hysterectomy was the only thing close that I could come up with. There isn't anything else

Dexafused

For dexa we can code osteoporisis, osteopenia, or menopausal condtions if not documentation for those condition than we can code screening (V82.81) as primary diagnosis.