Your practice is going to have more patients coming in for bone density screenings, thanks to new recommendations from the U.S. Preventive Services Task Force (USPSTF) that might lower the age at which family physicians could begin screening some women for osteoporosis. Act now to ensure you’re assigning the correct diagnosis codes and verifying medical necessity.
1. Know Osteoporosis, Osteopenia Differences
Many people think of osteoporosis when they hear the term “bone density screening.” Osteoporosis — which literally means “porous bone” — is a disease characterized by low bone mass and structural deterioration of bone tissue. The changes lead to bone fragility and an increased risk of hip, spine, and wrist fractures. The condition is essentially a bone disease caused by dropping estrogen levels in postmenopausal women.
When your physician diagnoses osteoporosis, you’ll select from code family 733.0x (Osteoporosis). Choose the diagnosis based on the patient’s specific type of osteoporosis (such as postmenopausal, idiopathic, etc.). A less-thought-of diagnosis related to bone density screenings is osteopenia (733.90, Disorder of bone and cartilage, unspecified). Patients with osteopenia have lower than normal bone density.
Although osteopenia can be a risk factor or precursor for osteoporosis, not every patient with osteopenia develops osteoporosis.
Screening: Your physician will most likely order a dual-energy x-ray absorptiometry (DXA), which measures bone density, to diagnose the condition. DXA is the gold standard for measuring bone density, coder Donna Richmond with CodeRyte taught in The Coding Institute’s audioconference “Surefire Bone Density Screening Strategies.” Your code choices include:
- 77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
- 77081 — … appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
- 77082 — … vertebral fracture assessment.
2. Check for Documented Necessity
Medicare guidelines dictate that your documentation must include an…