Superb guide for DEXA Bone scan cpt code

DEXA Bone scan cpt code in Details
Dual-energy X-ray absorptiometry (DEXA) assessment of bone mineral density of the femoral neck (A) and the lumbar spine (B) (Photo credit: Wikipedia)

Define DEXA cpt exam

Definition: Bone mass measurement is a radiologic or radioisotopic procedure that is used to assess bone density, detect bone loss or determine bone quality. It is also used to evaluate the effectiveness of osteoporosis drug therapy. Bone density can be measured with dual energy x-ray absorptiometry (DEXA), single energy x-ray absorptiometry (SEXA), radiographic absorptiometry (RA) or photodensitometry, quantitative computed tomography (QCT), single photon absorptiometry (SPA) or bone sonometry (i.e., ultrasound). Earlier technologies, such as dual photon absorptiometry (DPA), are no longer used.Bone mass density is scored by comparing test results to a reference range based on the average healthy young adult. 1.0 to 2.5 standard deviations below the reference range is considered osteopenic. Greater than 2.5 standard deviations from the norm is deemed to be osteoporotic. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which is surely help in clearing CPC exam. 

Read also:  killer tips for coding Add-on CPT codes


Procedure Description
Cpt code
Ultrasound bone density measurement and interpretation, peripheral site(s), any method

76977
Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)
77078
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis and spine)

77080
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton

77081
Bone density study, 1 or more sites; single photon absorptiometry

78350
Bone density study, 1 or more sites; dual photon absorptiometry

78351
Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)
G0130





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 Dual energy x-ray absorption (DEXA), 77080-77081: This technique uses low-level ionizing radiation to provide direct measurements of bone density. The precision error is low compared to other techniques and is useful in evaluating trabecular bone in locations beneath large amounts of soft tissue (e.g., lumbar vertebrae and proximal femur). It can also be used to measure peripheral sites. Quantitated computerized tomography (QCT), 77078: This technique uses ionizing radiation, but at a much higher exposure level than DEXA, without any superiority in precision or accuracy. QCT makes measurements in 3-dimensional sections of the spine. Single energy x-ray absorptiometry (SEXA), G0130: This technique is suitable for scanning the wrist. It is preferred over the single photon absorptiometry, which requires injection of a radionuclide. Ultrasound bone densitometry, 76977: This is a newer technique that does not expose the patient to radiation. The speed of sound through bone and attenuation of the ultrasound signals are the measurements used. Only peripheral sites are measured. This procedure may be used in physician offices or clinics as a prescreening for the more resource intensive DEXA procedures.



Documentation support for DEXA cpt

History and Physical: A full history and physical should be obtained from the referring physician detailing the condition that deems the Bone Mass Measurement necessary.
Final Note/Summary: The final note should indicate the procedure(s) performed. Follow up and treatment options should also be documented.

Indication for DEXA cpt code.

Candidates for Bone Mass Measurement fall primarily into the following categories:
Women who have been determined to be estrogen-deficient and at clinical risk for osteoporosis due to menopause (natural or induced), ovarian disease, or ovarian failure.
Individuals with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis,osteopenia (low bone mass), or vertebral fracture. Individuals receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5.0 mg ofprednisone, or greater, per day, for more than 3 months. The most common diseases requiring long-term
steroid treatment are asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and multiple sclerosis.
 Individuals with hyperparathyroidism.
 Individuals with malabsorption syndrome.
 Individuals with liver or kidney disease.
 Individuals being monitored to assess their response to or efficacy of an FDA- approved osteoporosis drug therapy.


REIMBURSEMENT ISSUES:
Medicare does not cover BMM performed by single photon absorptiometry, 78350, under any circumstances. BMM procedures 76977, ultrasound, 77078, QCT, 77080, DEXA of the axial skeleton, 77081, DEXA of peripheral skeleton, and G0130, SEXA of peripheral skeleton are covered by Medicare for screening for osteopenia and osteoporosis. A diagnosis code indicating that the reason for the test is postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy must be submitted on the claim.When BMM is being performed to monitor the efficacy of osteoporosis drug therapy, claims with procedure code 77080, DEXA of the axial skeleton, must be submitted one of the following diagnosis codes as the reason for the test: 733.00-733.09, osteoporosis, 733.90, osteopenia, or 255.0, Cushing’s syndrome. Claims with procedure codes 76977, 77078, 77081, or G0130 must contain a diagnosis code indicating postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy in addition to a code for osteopenia, osteoporosis, or Cushing’s syndrome. A confirmatory baseline BMM is only covered when it is performed with a dual-energy x-ray absorptiometry system (axial skeleton) and the initial BMM was not performed by a dual-energy x-ray absorptiometry system (axial skeleton). A confirmatory baseline BMM is not covered if the initial BMM was performed by a dual-energy x-ray absorptiometry system (axial skeleton).

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