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DEXA Scan - Screening or Diagnostic

  1. #1
    Question DEXA Scan - Screening or Diagnostic
    Medical Coding Books
    I have a patient who recently had a DEXA scan. This is a non-Medicare patient, but this question applies to all carriers.

    If the patient is scheduled for a screening, but when the scan is interpretted, the patient is found to osteopenic. Is the primary dx the screening or the osteopenia?

    I struggle with this because with Medicare, if the patient is scheduled for a screening colonoscopy and you end up doing a polypectomy, you still code the primary dx as screening and then the findings of the pathology. Shouldn't the same apply to DEXA scans? And for that matter, Mammograms.

    Anyone have any thoughts, suggestions, links, information?

    Please share.



  2. Default
    A screening is a screening is a screening. So I agree with you that if it's ordered as a screening then it's a screening with the findings coded 2nd. Same for mammograms.

    Diane Huston, CPC,RCC

  3. Default osteopenia range??
    what if the report states patient is in the osteopenia range. Does this get coded as osteopenia?

  4. #4
    Columbia, MO
    No it is still screening first listed if that is the reason for the test. The findings are listed as secondary for all carriers for all screenings. Per the guidelines for coding and reporting ICD-9

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    on my patient for the dexa scan the dr put screening on the order and in the impression it states " ostepenia range." I was told to code both the screening and osteopenia. I wasnt sure if I should be coding osteopenia since it said "range" so I should be coding both in this case?? Its ok to code osteopenia even though it states range?

  6. Default Dexa
    Nope..around here, if it's a screening, it's a screening. Just like with the screening mammos- if it's a screening mammo and they find a mass, you don't just change it. Unfortunately, a lot of these are not going to be paid for that reason.

  7. #7
    Wink Thank you
    Thanks to everyone who posted. Your thoughts are greatly appreciated and based on other postings, it seems to be a commom problem.

    Cory Bauer
    Rochester, MN

  8. Default
    Just a reply on the screening mammos because I've done thousands of these. If they find something on the screening mammo (mass, microcalcification), then proceed to perform a diagnostic mammo or ultrasound on the same visit/encounter, then code the mass/microcalc first, followed by the code for screening.

  9. #9
    Columbia, MO
    Sorry but the coding guidelines specify that when the purpose of the encounter is screen then screening remains the first-listed dx regardless of the finding or any other procedure performed due to those findings. So the screening code is first and the mass/microcalc is second.

    Debra A. Mitchell, MSPH, CPC-H

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