Wiki DEXA SCAN CPT 77080 and 77082

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thopkins30

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We are having trouble getting pd for the vertebral fracture assesment (77082) when billed with 77080. BCBS is denying this as not being medically necessary or other carriers are denying it for being experimental. We are billing this service w/ dx V82.81, V49.81 or 733.90, yet they are not being pd. Can someone please help me with getting this paid by the insurance company? Is anyone being reimbursed for the vertebral assesment?


Thanks for your help in advance,

Tamara, CPC, CPAR
 
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I'm looking into this too. Did anyone ever get an answer? My instinct tells me you need a reason to add this to a DEXA study, such as a suspected fracture.
 
I'm looking into this too. Did anyone ever get an answer? My instinct tells me you need a reason to add this to a DEXA study, such as a suspected fracture.

Yep, here's what I found on the CMS.gov website:

Article ID Number A51974

CPT code 77082 is considered by Medicare to represent vertebral fracture assessment only. Because code 77082 does not represent a bone density study, it should NOT be billed for screening. This code may be billed when medically necessary (i.e. when a vertebral fracture assessment is required). Symptoms should be present and documented, and it should be anticipated that the results of the test will be used in the management of the patient.
 
thopkins30 said:
We are having trouble getting pd for the vertebral fracture assesment (77082) when billed with 77080. BCBS is denying this as not being medically necessary or other carriers are denying it for being experimental. We are billing this service w/ dx V82.81, V49.81 or 733.90, yet they are not being pd. Can someone please help me with getting this paid by the insurance company? Is anyone being reimbursed for the vertebral assesment?


Thanks for your help in advance,

Tamara, CPC, CPAR
Click to expand...

Hi Tamara, the 77080 is the parent code. CPT directs not to bill them together as the (now) 77085 includes the work of 77080. You can do one, but not the other.
 
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