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Radiology coding question -bonemineral density

  1. #1
    Default Radiology coding question -bonemineral density
    Medical Coding Books
    hi everyone

    pt came for bonemineral density of the spine and hip testcpt code 77080
    dr wrote on script v82.81 and 733.00
    radiology report imp say pt has osteopenia
    i use adimit code v82.81(screnning for osteoporosis)
    i use primary code v82.81 and
    secondary code 733.90(osteopenia) and medicare denied any one has better
    soulation for this senior how i code this chart or any website i can go for screnning guideline


    please help me
    thanks

  2. #2
    Location
    Fayetteville, NC
    Posts
    300
    Default
    Does your physician perform the test and interpet the results or just interpret the results.
    If your office doesn't actually perform the test you need to be billing 77080-26. Just a thought without knowing why you are being denied it's hard to say what needs to be corrected.
    What does that denial say as the reason that you are not being paid?

  3. #3
    Default
    thanks

    i am coding for hospital outpt radiology test is perfrom at hospital in radiology dept medicare denied because i put primary dx v8281.

  4. #4
    Location
    First Hill, Seattle WA
    Posts
    65
    Default V82.81
    V82.81 is a Screening code and I beleive there is a NCD on CMS's website for DEXA scans as patients must meet specific criteria for reimbursment there might also be specific time-frames involved. Even it is retired, it's always a good idea to reference these if one exists for a particular CPT code. If the patient has known osteoporsis and is on medication for the condition, why the V82.81 because at this point and time I don't think it would be considered a screening but more of a follow-up to treatment for a known condition (733.00 osteo and V58.69 chronic use of high-risk medication).

    Check the CMS website to make sure.

  5. #5
    Location
    Fayetteville, NC
    Posts
    300
    Default
    The 733.90 primary on the scan should pass it per the Medicare LCD's.

  6. #6
    Default
    Quote Originally Posted by harshila View Post
    hi everyone

    pt came for bonemineral density of the spine and hip testcpt code 77080
    dr wrote on script v82.81 and 733.00
    radiology report imp say pt has osteopenia
    i use adimit code v82.81(screnning for osteoporosis)
    i use primary code v82.81 and
    secondary code 733.90(osteopenia) and medicare denied any one has better
    soulation for this senior how i code this chart or any website i can go for screnning guideline


    please help me
    thanks
    I'm assuming you work at a diagnostic facility since you stated "pt came for bone mineral density..." That being said, you always code the primary diagnosis from the impression of the Rad report. Being an outpt diagnostic facility allows you to also code from the findings. If the findings are negative or inconclusive then you would code the signs and symptoms.

    It's been my experience that medicare won't pay for certain v codes, v82.81 is one of them in my region. You must check medicares LCD in your region. To my knowledge they do pay 733.00 as well as v58.65 and v58.69 with accompanying documentation. Again you must check with your local MCR office.

    Just a suggestion try re-billing w/o the v code or use another vcode (2ndary)to show the use of steroids or hormonal replacement therapy if so documented.

    Also you can try this website for medicare.

    http://www.ngsmedicare.com

    Hope this helps

    Tonyj

  7. #7
    Default
    Do not remove the screening as your primary diagnosis or you are failing to follow coding guidelines. If a DEXA is ordered as a screening, it must be coded as V82.81 and the osteopenia or osteoprosis can be the secondary code.

    This is where the importance on an ABN would come into place!!

  8. #8
    Default
    Please review Coding Guidelines Section IV chapter L (patients receiving diagnostic test only)"....code any confirmed or definitive diagnosis documented in the interpretation...."

    I stand by what I said. Try rebilling with the primary diagnosis as 733.00 after you've checked with medicare's LCD

    Tonyj

  9. #9
    Default
    Medicare won't cover a screening code. The pateint MUST have one of the following criteria for Medicare coverage of a DEXA:

    256.9 ovarian dysfunction
    733.90 osteopenia
    733.00 osteoporosis
    737.30 Scoliosis

    other indicators that would be considered by MCR include vertebral abnormalities demonstrated by Xray to be indicative of osteoporosis, osteopenia, or vertebral fracture; an individual receiving glucocorticoid (steriod) therapy equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months; An individual being monitored to assess the respone to or efficacy of an FDA-approved osteoporosis drug therapy.

    That being said, if the phsyician writes the order with the screening code, you have to code it that way. Our facility has a standardized DEXA specific order sheet that is used, specifically when the patient has clinical indicators for bone density problems and we don't get dinged for the screening issue by using it.

    If it is truly just a screen, then the doc writes that order out seperately indicating that it is simply a screen, and we have the patient sign an ABN for it.

    Hope that helps.

    Hope that helps.

  10. #10
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by Tonyj View Post
    Please review Coding Guidelines Section IV chapter L (patients receiving diagnostic test only)"....code any confirmed or definitive diagnosis documented in the interpretation...."

    I stand by what I said. Try rebilling with the primary diagnosis as 733.00 after you've checked with medicare's LCD

    Tonyj
    Yes but the guidelines also state that when the reason for the exam is screening then screening remains the first-listed dx. The section you are quoting is for diagnostic tests and a screening test is not a diagnostic it is screening. The screening V code must remain primary. If the patients plan states that screening is non covered then I do not need an LCD the patient can be held responsible.
    We CANNOT change the scenario with dx codes JUST TO GET THE INSURANCE TO PAY A CLAIM! If it is screening then you have coded it correctly with the V code first. Bill the patient. If the patient is on phosamax and this test is to monitor the medication then you use V58.83 first then the V58.69 second, this is per coding clinics.

    Debra A. Mitchell, MSPH, CPC-H

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