Wiki Medicare Denials for Screening Bone Mineral Density DEXA CPT 77080

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
C
Medicare Denials for Screening Bone Mineral Density DEXA CPT 77080

Per the Medicare Claims Processing Manual, chapter 13, section 140.1, Dual-energy X-ray Absorptiometry (DXA) tests are covered when used to monitor FDA-approved osteoporosis drug therapy, subject to the two-year frequency standards described in chapter 15, section 80.5.5 of the Medicare Benefit Policy Manual.

Contractors will pay claims for monitoring tests when coded with 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) when reported with diagnosis code M81.0 Age-related osteoporosis without current pathological fracture, M81.8 Other osteoporosis without current pathological fracture, M81.6 Localized osteoporosis [Lequesne], or M94.9 Disorder of cartilage, unspecified.

According to a 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.

coffee2day

Networker
Messages
62
Location
Santa Clara, CA
Best answers
0
Hello, we are receiving denials for screening dexa scans CPT 77080 with diagnosis Z13.820 screening for osteoporosis.

Per Medicare article MM5521, screenings are allowed every 2 years, but we are being denied. The denial is for NCD, as Medicare NCD 150.3 does not list the Z screening code.

Any help would be greatly appreciated.
 

CodingKing

True Blue
Messages
3,955
Best answers
1
Losing my mind today so i'm going to repost:

There are many routine tests that are not covered by Medicare without meeting diagnostic criteria. Must meet one of the following 5 criteria for DEXA every 2 years. The screening code can be used but it not as the primary DX.

  • A woman who has been determined by the physician or a qualified nonphysician practitioner treating her to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other findings;
  • An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass), or vertebral fracture;
  • An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of prednisone, or greater, per day, for more than three (3) months;
  • An individual with primary hyperparathyroidism;
  • An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy.
 
Last edited:

CodingKing

True Blue
Messages
3,955
Best answers
1
So would you appeal the claim with medical records, or just do a corrected claim with correction to diagnosis? Same denials here.
Corrected claim with the DX documented in the Medical record (As long as it wasn't added to the record after claim submission).
 
Messages
1
Best answers
0
We are using M95.1 as a primary and Z13.820 as a secondary and it has been more than 2yrs and our medicare Dexa's are still being denied. Any other suggestions?
 
Top