Thursday, September 16, 2010

Billing CPT 77080, 77081, 77082 with covered dx

REIMBURSEMENT CODES FOR BONE DENSITOMETRY

The new Balanced Budget Amendment, signed into law, mandates preventative care for high risk individuals, and guarantees Bone Density Reimbursement even if the test is negative and also requires all states to pay for the codes below starting July 1998.

CPT Code 77080 - Hip, spine or central DEXA (Dual Energy X-Ray Absorptiometry) studies.
CPT Code 77081 - Peripheral DEXA Bone Mineral Density
CPT Code 77082 - Peripheral Ultrasound Bone Mineral Density

Indications for DEXA

  Estrogen deficiency
  Osteopenias
* Osteoporosis
* Crush fractures of the spine
  Thyroid Disease
  Cushing's Disease
* Long-term corticosteriod use
  Osteomalacia
* Hyperparathyroidism
* To monitor course of therapy
* Recent fracture of hip, spine, etc.

Commonly Used ICD-9 Codes

ICD-9 Diagnosis
*252.0 Hyperparathyroidism
  255.0 Cushing Syndrome
*256.2 Post Oblative Ovarian Failure - Age 40 and below
*256.3 Primary Ovarian Failure - Age 40 and below
  256.30 Premature Osteoporosis
+256.8 Ovarian Dysfunction
  257.2 Testicular Dysfunction
  268.2 Osteomalacia/Osteoporosis Syndrome
  269.1 Mineral Deficiency
  307.1 Anorexia Nervosa/Bulimia
  579.8 Malabsorption of Calcium
  585.0 Chronic Renal Failure
  588.0 Renal Osteodystrophy
  588.8 Secondary Hyperparathyroidism
+627.20 Menopausal Syndrome
  714.0 Rheumatoid Arthritis
  715.0 Osteoarthritis
  716.0 Arthritis
*733.00 General Osteoporosis
*733.01 Postmenopausal or Senile Osteoporosis
*733.02 Idiopathic Osteoporosis
  733.03 Disuse Osteoporosis
*733.09 Drug Induced Osteoporosis
*733.8 Diabetic Bone Changes
+733.90 Osteopenia
*733.09 Use with Patients on Following Drugs: Corticosteroids, Heparin, Phenytoin, Thyroid Replacements (only if TSH Level is Subnormal)
*805.2 Fracture of Thoracic Spine,Closed
*806.4 Fracture of Lumbar Spine, Closed
*807.01 Fracture of Rib, Closed, One Rib
*807.02 Fracture of Rib, Closed,Two Ribs
*808.0-808.9 Fracture of Pelvis
*820.0-820.9 Fracture of Neck Femur
*808.00 Pelvic Fracture
*813.41 Colles Fracture
*814.00 Wrist Fracture
*V58.69 Long Term (current) use of high risk medication. (Generally used with 733.09)
(+) Can be used in some states now (Not in Tennessee). Can be used after July 1, 1998 in all states along with all other codes listed.
(*) To get paid on negative or osteopenic studies one must use a code with (*) by it until July 1, 1998. Then all codes listed are acceptable for high risk (perimenopausal) individuals with two or more of the following risk factors:
• White or Asian Ancestry
• Excess Alcohol Consumption
• Low Body Weight
• Advanced Age
• Early Menopause
• Smoking History
• Family History of Osteoporosis
• Inadequate Calcium Intake
• Inactive Lifestyle
• Previous Fracture
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Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
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Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
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1) Relative Value Units (RVU)
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[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
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