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screening dexa dilemma

  1. #1
    Location
    Greeley, Colorado
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    Default screening dexa dilemma
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    Dexa is ordered as screening for osteoporosis (V82.81) and the report states findings as osteopenia (733.90). Coded V82.81, 733.90. Medicare does not pay for V82.81 as the primary dx - denies to patient responsibility. Based on ICD-9 guidelines I think this is coded correctly. Any other thoughts/comments?? Is there something I am missing?
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Location
    Sioux Falls South Dakota
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    358
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    Lisa,

    Medicare no longer has an NCD on DEXA scans, but instructions on who is covered, etc, are now in the claims processing manual. Here is a link to just that section (scroll down to pages 13and on): http://www.cms.gov/transmittals/downloads/R70BP.pdf

    They don't cover the V72.81 screening diagnosis - the conditions they cover are on page 15 of this document.

    Hope this helps!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Location
    Columbia, MO
    Posts
    12,572
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    When a test is performed as a screening, then the screening V code is always listed first regarless of the findings. This is stated in the coding guidelines.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Sioux Falls South Dakota
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    358
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    Yes, Debra is correct - and I meant to add that for a screening, the way it was coded was correct, and an ABN should have been obtained, explaining to the patient that a screening is not paid by Medicare. Sometimes I hit send too early (or get interrupted and forget that I meant to say more!!)
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. #5
    Location
    Fayetteville, NC
    Posts
    300
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    Stupid semi-question here. Say that a patient is given a dexa scan as a screening for osteoporosis but they have other signs or symptoms...like pain. Is the screening code still supposed to be primary?
    My docs do alot of colons and IMO if there is a rectal bleed or blood in stool I do not code for a screening. Should I be?

  6. #6
    Location
    Columbia, MO
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    It depends on what the documentation states. If the patient has a complaint of blood in stool and this is why the colonoscopy is ordered then it is not screening. On the other hand if the patient has no complaint and the test is ordered as a screening then it is a screening, even if there is a history of rectal bleeding it is not the reason for the test. If the dexa scan is ordered due to symptoms then it too is not a screening. We must go by the documentation of what is the reason for the test.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Greeley, Colorado
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    Quote Originally Posted by mitchellde View Post
    When a test is performed as a screening, then the screening V code is always listed first regarless of the findings. This is stated in the coding guidelines.
    Agreed. I was just getting some clarification to make sure I was on the right page. These are going to patient responsibility. I need to inform my docs that a screening dexa just isn't a Medicare benefit, which is really too bad.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Location
    Greeley, Colorado
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    2,045
    Red face
    OK...I must be over-thinking this. If the order states "post-menopausal screening for osteoporosis" how would you code this? You can't just assume V49.81; but if you research the record and find that she is truly "asymptomatic postmenopausal (age-related)(natural), wouldn't you still code V82.81 first? If she is asymptomatic then she is most likely not on HRT... so she is not "estrogen deficient"...My docs want to code V49.81, V82.81 and I think that's backwards. I am going to pull my hair out on this one!! Any advice is much appreciated!!!
    Lisa Bledsoe, CPC, CPMA

  9. #9
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    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.

    http://www.cms.gov/MLNProducts/downloads/Bone_Mass.pdf



    Stefanie Cramer, CPC
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

  10. #10
    Location
    Greeley, Colorado
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    Thank you Stefanie.
    So, when your docs order screening postmenopausal, what order do you list the dx codes?
    Lisa Bledsoe, CPC, CPMA

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