Basics about DEXA scan CPT code 77080 & 77081
DEXA stands for Dual energy X-ray absorptiometry. DEXA scan is done to evaluate the density of the bone. This test is done specially to screening test for osteoporosis. Osteoporosis is caused when there is significant decrease in the density of the bone. DEXA scan Cpt code is divided on the basis of the bones studied during the exam. The codes for appendicular and axial skeleton have different CPT code for DEXA scan. Dual energy x-ray absorptiometry (DEXA) is a two-dimensional projection system that involves two x-ray beams with different levels of energy being pulsed alternately. So, we have two most common CPT code for DEXA scan
77080 – DEXA scan for axial skeleton 1 or more sites (hips, pelvis, and spine)
77081 – DEXA scan for appendicular skeleton 1 or more sites (peripheral) (radius, wrist, and heel)
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ICD 10 diagnosis for bone density DEXA scan CPT code 77080 and 77081
Patient will have to under DEXA scan when they are have vertebral abnormalities. Also, when there’s deficiency of estrogen or ovarian disease or failure. Hyperparathyroidism also may lead the physician to perform DEXA scan. Signs and symptoms related to bone mostly undergo DEXA scan to find any diagnosis with the density of bone like osteopenia or osteoporosis(M81.0).
M85.80 – Other specified disorders of bone density and structure, unspecified site
M81.0 – Age-related osteoporosis without current pathological fracture
DXA measurement of the hip and spine is the most common technology used to establish or confirm a diagnosis of osteoporosis, predict future fracture risk and monitor patients by performing serial assessments. Areal BMD is expressed in absolute terms of grams of mineral per square centimeter scanned (g/cm2) and as a relationship to two norms: compared to the BMD of an age-, sex-, and ethnicity-matched reference population (Z-score), or compared to a young-adult reference population of the same sex (T-score). The difference between the patient’s BMD and the mean BMD of the reference population, divided by the standard deviation (SD) of the reference population, is used to calculate the T-score and Z-score. According to the World Health Organization (WHO) diagnostic classification, osteoporosis is defined by BMD at the hip or lumbar spine that is less than or equal to 2.5 standard deviations below the mean BMD of a young-adult reference population.
Osteoporosis is a systemic condition that affects all bones of the musculoskeletal system and leads to an increased risk of pathological fractures. In osteoporosis, the bones are thinner and weaker than normal. Osteoporosis is classified to categories M80 and M81 depending on whether a current pathological fracture is present or not. Because osteoporosis is a systemic condition, site is not a component of the codes under category M81, Osteoporosis without current pathological fracture. The codes under category M80, Osteoporosis with current pathological fracture, identify the osteoporosis and the site of the pathological fracture.
Indications for Bone Mineral Density Testing:
• All women ≥65 years old
• All postmenopausal women
With a history of fracture(s) without major trauma
With osteopenia identified radiographically
Starting or taking long-term systemic glucocorticoid
therapy (≥3 mo)
BMD testing should be performed in men:
• age 70 and older, regardless of clinical risk factors
• age 50-69, with clinical risk factors for fracture
• over age 50 who have had an adult age fracture
• with a condition (e.g., rheumatoid arthritis) or taking a medication (e.g., glucocorticoids in a daily dose ≥
5 mg prednisone or equivalent for ≥ three months) associated with low bone mass or bone loss
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Diagnosis used with CPT code 77080 and 77081 for DEXA scan
The most common diagnosis used with DEXA scan for osteopenia 733.90 and osteoporosis 733.00. If no diagnosis is present we are allowed to use Screening code for Osteoporosis V82.81. Also we have Postmenopausal status code V49.81 used while coding CPT code for DEXA scan. There is a combined code for postmenopausal and osteoporosis called as Senile Osteoporosis 733.01. Don’t code separately when postmenopausal and osteoporosis when both are present along with CPT code for DEXA scan.
ICD 10- codes
Osteopenia (733.90)
M89.9- Disorder of bone, unspecified
M94.9- Disorder of cartilage, unspecified
Osteoporosis (733.00)
M81.0 -Age-related osteoporosis without current pathological fracture
Senile Osteoporosis (733.01)
M81.0 -Age-related osteoporosis without current pathological fracture
Screening for osteoporosis (V82.81)
Z13.820 Encounter for screening for Osteoporosis
Postmenopausal status (V49.81)
Z78.0 Asymptomatic menopausal state
Z79.3 Long term (current) use of hormonal contraceptives
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.83 Long term (current) use of bisphosphonates
Z87.310 Personal history of (healed) osteoporosis fracture
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CCI edit with CPT code 77080 and 77081 for bone density scan
When both 77080 and 77081 are performed on same day we have to use modifier to bypass the CCI edits. As per the edits we have to append 59 modifier with CPT code 77080 to bill both the procedure (77080-59). Both the procedures are paid only with proper use of 59 modifier, if missed these procedure will not paid.
Also, the CPT code 77080 should not be reported with procedure code 77085 & 77086.
77085 – Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment
77086 – Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)
Guidelines for CPT code 77080 & 77081 for Medicare
For those individuals who are eligible, Medicare will pay for a bone density study once every two years, or more frequently if the procedure is determined to be medically necessary. Medically necessary exceptions to the frequency limitation may include individuals on long-term steroid therapy for more than 3 months, individuals with hyperparathyroidism, or a confirmatory baseline measurement to permit monitoring in the future on an axial densitometer when the initial measurement was not performed by this system. Commercial function in your organization may or may not follow these guidelines; please refer to your local policy for details.
In the office setting, a physician who owns the equipment and performs the service may report the global code without a -26 modifier.
When the bone density test/study is performed in the hospital outpatient setting, physicians may not submit a global charge to Medicare because the global charge includes both the professional and technical components of the service. If the procedure is performed in the hospital outpatient setting, the hospital may bill for the technical component of the bone density test/study service as an outpatient service. The CPT code filed by the hospital will be assigned to a hospital outpatient system Ambulatory Payment Classification (APC) payment system, and payment will be based on the APC grouping. However, for Medicare, the hospital outpatient facility and the physician must report the same CPT code. If the physician is a hospital employee, the hospital may
submit a charge for the global service.
References:
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0300_coveragepositioncriteria_bone_mineral_density_measurement.pdf