Osteoporsis coding question.

lhommes

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We have been having issues with getting a drug called Zometa covered becuase of a coding issue. The issue is the code we are told to use for chemo induced bone loss is 773.09 which is the same code for Osteoporsis. Which is fine except for the patient's that don't have osteoporsis they have "chemo induced bone loss,"or what the Dr. would consider osteopenia 773.90 b/c they haven't reached the full level of osteoporsis. To our knowledge there isn't a code just for chemo induced bone loss. Our drug rep claims other offices are getting this covered. Any suggestions on what would be the correct way to code this?
 

adevine

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Our drs. are pathologists, not strictly ortho, but we do work on bone & articular cartilage specimens. From what I can see in ICD-9, osteopenia is coded the same as osteoporosis. Your docs may have a preference for 733.90 for this condition, but since 733.09 is very nearly the same (except that it gets your claim paid!), you may want to go over both code descriptions with your docs with an eye to adjusting their attitude & allowing the claim to carry a code that the payor(s) want to see. Some payors just want certain conditions linked to certain codes, even if there is more than one diagnosis code that might be applicable. You can be compliant and still make them happy, and collect revenue.
 

mitchellde

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I would use the osteopenia code as that is what it sounds like the physician has documented also use the E code for adverse condition due to antineoplastic drugs and it should be fine, along with the hx of neoplasm code.
 
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