Bone density dexa scan/test  CPT code 77080 & 77081 

Bone density scan is performed to check the density of bones. We use to do bone density scan to check osteopenia (733.90, ICD10-M85.80) or osteoporosis (733.00, ICD10-M81.0) presence in bones. The amount of calcium correlates with bony content and with bone strength. The bone strength decreases with increase of age, hence the calcium content plays a key role in strengthening of bones. CPT code 77080 & 77081 are used for coding DEXA bone density/test exam.

Medical coders use ICD 10 code Z13.820, for  Screening of bone density for osteoporosis. Osteopenia and osteoporosis both are caused because of low density in bone.Osteoporosis is generally more severe than osteopenia. Both are the most common diagnosis found during bone density exam coding. Moreover, we have very limited ICD 10 and CPT codes for coding DEXA(Dual-energy X-ray absorptiometry) scan. We will see later in this article, the CPT codes used for bone density exam and how they differ from each other.

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T and Z score DEXA scan/test CPT code 77080 & 77081

Bone mineral density (BMD) can be measured with a variety of techniques in a variety of sites. Sites are broadly subdivided into central sites (e.g. hip or spine) and peripheral sites (e.g. wrist, finger, heel). While BMD measurements are predictive of fragility fractures at all sites, central measurements of the hip and spine are the most predictive. Additionally, fractures of the hip and spine (e.g. vertebral fractures) are the most clinically relevant. The most commonly used techniques are Dual X-ray Absorptiometry (DXA), Quantitative computed tomography (QCT), and Ultrasound Densitometry.

The bones density decreases after a certain age, mostly after 55 or 60. Hence, it is important to go through DEXA scan which shows the true mass of your bone or skeleton. Men and Women who are between 55 to 65 ages, are recommended to go for BMD analysis periodically, to check for any risk of diseases like osteoporosis. DEXA is the best method which is painless and quick for BMD analysis.

T score shows the strength of bone compared with a young adult of the same gender with peak bone mass. As per the criteria of the World Health Organization, T score above -1 is considered normal, score between -1 and -2.5 is classified as Osteopenic and a T score below -2.5 is considered as  Osteoporotic. T score is used to estimate your risk of developing a fracture.

Covered Diagnosis for bone density Dexa Scan CPT codes

• Asymptomatic menopausal state
• Long term (current) use of hormonal contraceptives
• Long term (current) use of inhaled steroids
• Long term (current) use of systemic steroids
• Long term (current) use of bisphosphonates
• Personal history of (healed) osteoporosis fracture

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DEXA Bone scan/test CPT Code 77080, 77081, 77085 & 77086

Previous for coding DEXA scan, we use to have to major codes for coding Bone density procedure that is DEXA scan. Till 2014, we have used codes 77080 and 77081. Cpt code 77080 is used to code for bone density scan of axial bones like hip, pelvis and spine while 77081 was used to code axial bone like wrist, radius, heel etc. below is there detail description.

77080 Dual-energy X-ray absorptiometry (DEXA), bone density, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)

77081 Appendicular skeletons (peripheral) (e.g., radius, wrist, heel)

CPT code 77082 got deleted in 2015 for bone density scan. We are using cpt code 77086 in place of 77082. Lets check out these CPT codes.

There are two new codes have been introduced in 2015 for DEXA scan or bone density scan. These cpt codes will include the old codes and should never be coded with these codes. Below are the CPT codes used from 2015.

77085  Dual-energy X-ray absorptiometry (DEXA), bone density, 1 or more sites; Axial skeleton (e.g., hips, pelvis, spine), including vertebral fracture assessment 

77086  Vertebral fracture assessment via dual-energy X-ray absorptiometry (DEXA) 

Additionally, CPT code 77086 was created to report a vertebral fracture assessment via DEXA. Note, exclusionary language has been added in the CPT manual for instructions on how to appropriately bill for these two new codes.

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Medicare covers Bone Mass Measurement under the following conditions:

• Is ordered by the physician or qualified NPP who is treating the beneficiary following an evaluation of the need for a BMM and determination of the appropriate BMM to be used.
• Is performed under the appropriate level of physician supervision

• Is reasonable and necessary for diagnosing and treating the condition of a beneficiary
• Is performed with a dual-energy x-ray absorptiometry system (axial skeleton), in the case of an individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy,
• Is performed with a dual-energy x-ray absorptiometry (DXA),(DEXA) system (axial skeleton) for monitoring tests or confirmatory testing if the initial scan was not DXA.

To be covered, a beneficiary must meet at least one of the five conditions listed below:

• A woman who has been determined to be estrogen-deficient and at clinical risk for osteoporosis
• An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.
• An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months.
• An individual with primary hyperparathyroidism.
• An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapy.

Medicare pays for a screening BMM once every 2 years (at least 23 months have passed since the month the last covered BMM was performed).

• More frequently if medically necessary
 Examples include, but are not limited to, the following medical circumstances:
o Monitoring beneficiaries on long-term glucocorticoid or steroid therapy of more than 3 months.
o Confirming baseline measurements to permit monitoring of beneficiaries in the future.

When Bone Mineral Density Studies are not covered

• Bone mineral density studies are considered not medically necessary if the criteria listed above are not met.
• Screening individuals who are at low risk for osteoporosis is considered not medically necessary.
• Bone mineral density measurement using ultrasound densitometry, quantitative computed tomography, or dual x-ray absorptiometry of peripheral sites is considered investigational.
• Peripheral or appendicular bone density studies are considered not medically necessary except as noted above.
• Dual x-ray absorptiometry (DXA) body composition studies are considered investigational.

Related Bone density dexa/test scan CPT codes & HCPCS codes

77085  Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment 1 or more sites (Non-covered by Medicare)

0508T Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia (Effective 07/01/2018)

0554T Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report (Effective 07/01/2019)

0555T Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data (Effective 07/01/2019)

0556T Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; assessment of bone strength and fracture risk and bone mineral density (Effective 07/01/2019)

0557T Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan;
interpretation and report (Effective 07/01/2019)

0558T Computed tomography scan taken for the purpose of biomechanical computed tomography analysis (Effective 07/01/2019)

G0130  Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)

Revenue code

320 Radiology – diagnostic

Do and Don’t for DEXA Bone density CPT Code 77080 & 77081

Do not report 77080 in conjunction with 77085, 77086

Do not report 77085 cpt code in conjunction with 77080, 77086

Do not report 77086 cpt code in conjunction with 77080, 77085

While coding 77085 and 77081 together do remember to use modifier XU with cpt code 77081. Since coding both cpt code together have a CCI edit which is bypassed by using XU modifier.

While coding 77081 and 77080 together do remember to use modifier XU with cpt code 77080.

Sample Coded chart for bone density DEXA scan/test CPT code 77080 & 77081

EXAM: SAT DXA BONE DENSITY AXIAL 1+SITES

REASON FOR STUDY:  Menopause present, Decrease in height

CLINICAL HISTORY: Postmenopausal female with decrease in height.

TECHNIQUE:
Lumbar Spine: No technical issues in BMD measurement.
Total Hip: No technical issues in BMD measurement.
Femoral Neck: No technical issues in BMD measurement.

FINDINGS:
The T-score of the lumbar spine is -0.2.
The T-score of the total hip is -1.1.
The T-score of the femoral neck is -1.6.
The bone mineral density of the lumbar spine is 1.030 grams per centimeter squared.
The bone mineral density of the total hip is 0.811 grams per centimeter squared .
The bone mineral density of the femoral neck is 0.674 grams per centimeter squared .

IMPRESSION:
1. The bone mineral density measured at the left femoral neck is 0.674 g per cm2 which corresponds to a T-score of -1.6. This patient is considered osteopenic according to the World Health Organization classification.

CPT code: 77080