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Thread: screening dexa dilemma

  1. #11


    AAPC: Back to School
    "Based on ICD-9 guidelines I think this is coded correctly."
    Yes indeed.
    Screening is the TEST for disease or disease Precursors IN SEEMINGLY WELL individuals so that early detection and management can be provided for those who test positive for the disease.- This is our Gold standard Like other examples narrated (in Diagnosis guidelines ), osteoporosis can affect anyone postmenopausal ( though mostly, it does not occur immediate post menopause) and though some are soon affected and some later( the physician, the best judge, seeks for the test only when she decides the patient needs it; however the point to emphasize is this: the incidence is higher in these group, though as postmenopausal number of years go up, the risk also goes up; of course, there are other Factors which make it faster for some.
    Health care expenditures in the United States that are attributed to osteoporotic fractures reach greater than $10 billion annually. Detection of osteoporosis by screening can lead to early treatments that can maintain bone mass, lowering the risk of osteoporotic fractures The Department of Health and Human Services' Health Care Financing Administration (HCFA) realized that the physician treating the beneficiary should be afforded flexibility and be given the option of ordering the most appropriate bone mass measurement for a patient in a particular set of circumstances.
    With regard to estrogen-replacement therapy (ERT), HCFA recognized the difficulty of trying to define the estrogen-deficient statutory category precisely. Rather than attempting to define the category, HCFA left the determination of whether the patient is estrogen-deficient and at clinical risk of osteoporosis to the treating physician. This risk is calculated based on medical history or other findings.

    After all the whole idea is to keep them fit which is their legitimate rights and at the age when they really has to depend incredibly on their OWNSELF, before they encounter an ‘attack’.

    Here is my argument:
    Well, while the career/payer accepts the screening for routine mammogram for women over 40, an amniocentesis for a pregnant women over 45, WHY NOT FOR POST MENOPAUSAL WOMEN, a screening for osteoporosis(all the more), at the time when the doctor feels she needs it? ( Of course, you know, the doctors are not sitting there fancied and wasting their time to go for screening for “not-in-need” cases. Give them a fair chance to lead a healthy self-dependant life.
    Finally what I am trying to drive at is : You emphatically go for the Vcode 82.81 as the primary,on these points for validation: being postmenopausal, asymptomic, the encounter is for screening for osteoporosis and the physician decision and documentation for the order, and above all, not the least, for the coders,our guideline's Principles.
    If I were in your shoes, I would do that.
    Thank you for your patient listening!

  2. #12
    Join Date
    Apr 2007
    Greeley, Colorado


    First of all - a HUGE THANK YOU to everyone who has posted on this thread!!!

    Second - what if the test is ordered as "screening for osteoporsis" but on the last dexa osteopenia was found. I believe it should still be coded V82.81, 733.90 as that follows guidelines. The only instance in which V82.81 would not be coded is if the provider ordered the dexa due to osteopenia...

    This is a huge deal, as all of these are going to patient responsibility. We own the dexa and do the interp, so the global fee is being billed to the patient by our clinic.
    Lisa Bledsoe, CPC, CPMA

  3. #13


    The only instance in which V82.81 would not be coded is if the provider ordered the dexa due to osteopenia...

    I dont know why at all? The medical necessity do not support this; osteopenia is just a step before the osteoporosis, meaning osteopenia is asort of a forerunner of osteoporosis.
    Here is my stand: Osteopenia is the thinning of bone mass. While this decrease in bone mass is not usually considered "severe", it is considered a very serious risk factor for the development of osteoporosis ,which is loss of bone mass.
    Bone mineral density (BMD) is the measurement of calcium levels in bones, which can estimate the risk of bone fractures. It is also used to determine if a patient has osteopenia or osteoporosis. While osteopenia can be diagnosed using plain radiographs, the most common method for measuring BMD (and a way to definitively diagnose osteoporosis) is through Dual Energy X-ray Absorptiometry or DEXA.

    Most people experience some loss of bone mass as they age, osteopenia and osteoporosis. Regular check-ups with a physician to monitor bone loss, especially in people over age 50., is one of the methods of PREVENTION. The measurements, known as T-scores, determine which category - osteopenia, osteoporosis, or normal - a person falls into

    Journal of the American Medical Association reported that a 50-year-old white woman with a T-score of -1 has a 16% chance of fracturing a hip, a 27% chance with a -2 score, and a 33% chance with a -2.5 score. But there isn't a huge difference between, say, a -2.3 T-score and -2.5, although the former would be labeled osteopenia and the latter, osteoporosis. "The label matters less than the number. These distinctions are to some extent arbitrary lines in the sand," says Dr. Maureen Connelly, a preventive medicine expert at Harvard Medical School. Regardless of your exact score, if you fall into the osteopenia category, your doctors will probably schedule you for a bone mineral density test every two to five years.

    This clip I presented not for arguement, but to have an idea that osteopenia does not make a huge defference in the pathological process and actually when osteopenia is confirmed it is the "fortune teller" /as a signal and merits the validity for doing DEXA.

    Thank you for your time!

  4. #14

    Default Coder Help

    Quote Originally Posted by Stefanie View Post
    I believe that most ladies over the age of 65 are postmenopausal, that doesn't necessarily mean the provider has determined that they are at clinical risk for osteoporosis ( I know that sounds crazy, but we can't assume right?) I have encouraged my providers to state the specific reason why they believe the patient is at risk for osteoporosis, whether's it postmenopausal or they have symptomatic menopausal symptoms etc. If they just state "due for dexa for osteoporosis screening" I don't use the V49.81, even if I can find that the patient is postmenopausal in the note, the provider didn't specifically state that was the reason for the dexa. Below is a great pamphlet from Medicare for providers on Bone Mass Measurement. It has helped me. Hope it helps you.

    should Code 627.9 be used with V82.81 or should I use V81.89 for DXA Bone Densitometry screening

  5. #15

    Smile Need Answer

    Quote Originally Posted by figdan45 View Post
    should Code 627.9 be used with V82.81 or should I use V81.89 for DXA Bone Densitometry screening
    should Code 627.9 be used with V82.81 or should I use V81.89 for DXA Bone Densitometry screening[/QUOTE]

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