Tips to help your Bone Density Coding

Here's an ob-gyn coding scenario: You ob-gyn orders an axial skeleton DXA for an estrogen-deficient female patient at risk for osteoporosis. You should code 77080.

And when your diagnosis coding system changes in 2013, V82.81 will become Z13.820 (Encounter for screening for osteoporosis). For measuring bone density, dual-energy x-ray absorptiometry (DXA) is the gold standard.

Here's how you can keep your DXA claims airtight

Your documentation should include an order from a physician or qualified nonphysician practitioner and an interpretation of the test results. Signing the machine printout does not count as an interpretation.

The doctor also needs to document a complete diagnosis. Even though Medicare does not offer a national list of covered ICD-9 codes, it does state that an individual qualifies for coverage when she meets some of these conditions:

• is estrogen-deficient and at risk for osteoporosis, is being monitored for FDA-approved osteoporosis drug efficacy has been diagnosed by x-ray with osteoporosis, osteopenia, or vertebral fracture, is receiving glucocorticoid therapy greater than or equal to 7.5 mg of prednisone per day for more than three months has primary hyperparathyroidismcacy.

Take a look at your payer's local coverage determination (LCD) for the specific ICD-9 codes it says support medical necessity.

Secondly, stick with documented diagnoses. Report the documented diagnosis only – never choose a diagnosis simply because you know you will get the payments for it. Remember: You should always code results to the highest level of specificity. For instance, for a woman who is postmenopausal and not taking hormones, you should report V49.81 (Asymptomatic postmenopausal status [age-related] [natural]).

Third, you should adhere to frequency guidelines. Medicare will pay for bone mass measurements on qualified individuals every couple of years.

Every couple of years means "at least 23 months have passed since the month" of the last bone mass measurement. Medicare does offer exceptions to this frequency rule. Payers may think about more frequent DXA scans when medically necessary under either of these circumstances, she adds:

• you are monitoring a patient on glucocorticoid therapy for more than three months
• you need a baseline measurement to monitor a patient who had an initial test using a different technique (such as sonometry) than the one you want to use to monitor the patient (such as densitometry).

For further details on this and for other specialty-specific articles to assist your ob-gyn coding, sign up for a good coding resource like Coding Institute.