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kyphoplasty ICD-10 DX for a Medicare patient

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574coding

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137
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Los Osos, California
So this is where the problem arises for our provider. Is a diagnosis of osteoporosis is necessary for a Percutaneous Vertebral Augmentation / Kyphoplasty? An osteoporotic vertebral compression fracture (VCF) is different than having a diagnosis of osteoporosis in general. This patient has a normal DEXA scan of her spine and therefore doesn't have osteoporosis, she does however have an osteoporotic VCF. According to the guidelines an osteoporotic VCF is required (also called fragility or low-trauma fractures) Please advise: with a normal DEXA scan but a concurrent fragility fracture, how do I proceed with the diagnosis that supports the procedure?
 
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Have you checked your LCDs? Can you use M80.88XA Other osteoporosis with current pathological fracture?
M80 guidelines in ICD10 "includes osteoporosis with current fragility fracture"
 
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