Wiki Medicare Denials for Screening Bone Mineral Density DEXA CPT 77080

[coffee2day]

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]

Sorry missed the 2 years part

 

[CodingKing]

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.

 

[coffee2day]

Thank you coding king! This helps a lot, we were going bonkers here trying to get it paid.

Thank you,

 

[rcanales]

So would you appeal the claim with medical records, or just do a corrected claim with correction to diagnosis? Same denials here.

 

[CodingKing]

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).

 

[AlaskanCoder]

So would you appeal the claim with medical records, or just do a corrected claim with correction to diagnosis? Same denials here.

I would call in a phone reopening with the appropriate diagnosis code(s).

 

[spazzgirl3]

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?

 

[nneecole44]

We are getting denials for the n95.1 now as well. Frustrating.