Section VI: Bone/Joint Studies (77071-77086

CPT 2015: Watch for changes in Vertebral fracture

assessment
Check Bone Density Study with Vertebral Fracture Assessment
Currently, you bank upon 77082 (Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites;
vertebral fracture assessment) for vertebral fracture assessment. Effective 2015, this code will no longer be valid. You
have two new codes for vertebral fracture assessment. These include 77085 (Dual-energy X-ray absorptiometry [DXA],
bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine], including vertebral fracture assessment)
where vertebral fracture assessment is done as part of bone density study and 77086 (Vertebral fracture assessment
via dual-energy X-ray absorptiometry [DXA]) which is for vertebral fracture assessment alone.

CPT created the "Bone/Joint Studies" subsection in 2007 the services were previously represented by codes in the
76xxx range.
For example: Long before, CPT 2007 deleted 76006 (Manual application of stress performed by physician for joint
radiography, including contralateral joint if indicated) and replaced it with 77071 (Manual application of stress
performed by physician or other qualified health care professional for joint radiography, including contralateral joint if
indicated). Code 77071's descriptor is identical to that previously used for 76006. CPT made the code change to allow
for more appropriate placement in the new subsection for Bone/Joint Studies.
Watch for: The bone and joint section of the radiology chapter is your source for dual- energy X-ray absorptiometry
(DXA) codes.
Stop on 77073 for CT Scanogram
You may wonder whether you may report 77073 (Bone length studies [orthoroentgenogram, scanogram]) for different
kinds of scanograms, or whether this code is just for X-rays.
The descriptor doesn't specify a modality (CT or X-ray, for example), and the code best describes the service rendered
for a scanogram, so 77073 is the accurate choice.
You also won't change how you code based on the number or type of views, although with X-ray scanograms, you often
see four exposures, with views of the hip, leg, knee, and ankle used to measure the long bones to assess growth
patterns.
Bonus bilateral tip: Code 77073 is bilateral, meaning that you should report the code only once even when you scan,
for example, two legs.

CPT 2014 American Medical Association. All rights reserved.

This code has a bilateral indicator of "0" on the Medicare Physician Fee Schedule, which means the payment
adjustment for a bilateral indicator doesn't apply.
Translation: You shouldn't add bilateral modifiers, such as 50 (Bilateral procedure) or RT (Right side) and LT (Left
side).
Reporting 77073 is accurate coding, and payers won't pay you any more if you add bilateral modifiers than if you
report 77073 without them.
Use 3 Tips to Make Bone Density Coding a Snap
Tracking Medicare's DXA claim restrictions on medical necessity and frequency can be a real chore. But you can
simplify the process and reduce denials by following this advice on keeping DXA claims airtight.
Tip 1: Confirm That Your Superbill Carries Updated DXA Codes
Long before, CPT changed the code numbers but not the descriptors for DXA.
Example: A physician orders an axial skeleton DXA for an estrogen-deficient female patient at risk for osteoporosis.
You report 77080 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g.,
hips, pelvis, spine]) for services performed and not 76075, the previous code.
Tip 2: Get Up to Snuff on National and Local Rules
Documentation tip: Your documentation needs to include an order from a physician or qualified nonphysician
practitioner and an interpretation of the test results (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.4).
Signing the machine print-out doesn't count as an interpretation.
The physician also needs to document a complete diagnosis. Medicare states that an individual qualified for coverage
will meet one of these conditions:
1. Is estrogen-deficient and at risk for osteoporosis (female only)
2. Has been diagnosed by X-ray with osteoporosis, osteopenia, or vertebral fracture
3. Is receiving glucocorticoid therapy greater than or equal to 7.5 mg of prednisone per day for more than three
months
4. Has primary hyperparathyroidism
5. Is being monitored for FDA-approved osteoporosis drug efficacy.
Check with your payer's LCD for the specific ICD-9 codes, it says support medical necessity.
Good news: Medicare covers 77080 (Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites;
axial skeleton [e.g., hips, pelvis, spine]) when (1) the physician uses that DXA service to monitor osteoporosis drug
therapy and (2) you report 77080 with an appropriate diagnosis code.
Examples of covered diagnoses include these:

255.0 Cushing's syndrome.

733.00 Osteoporosis, unspecified.
733.01 Senile osteoporosis.
733.02 Idiopathic osteoporosis.
733.03 Disuse osteoporosis.
733.09 Other osteoporosis.
733.90 Disorder of bone and cartilage, unspecified.

Note: Medicare doesn't cover bone mass measurement to monitor osteoporosis drug therapy using other procedures.

CPT 2014 American Medical Association. All rights reserved.

Result: Medicare won't pay if you report the above ICD-9 codes with these CPT codes:

76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method.
77078 Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (e.g., hips, pelvis,
spine).
77081 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton
(peripheral) (e.g., radius, wrist, heel).
G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton
(peripheral) (e.g., radius, wrist, heel).

Caution: Don't base your coding on what the payer will cover. Only report those codes the physician's documentation
supports.
Tip 3: Count Backward to Meet Frequency Requirement
Medicare will pay for bone mass measurements on qualified individuals every two years.
Translation: Every two years means "at least 23 months have passed since the month" of the last bone mass
measurement" (Medicare Benefit Policy Manual, Chapter 15, Section 80.5.5).
Medicare does offer exceptions to this frequency rule. Payers may consider more frequent DXA scans medically
necessary under either of these circumstances:

You're 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) (Medicare Benefit Policy
Manual, Chapter 15, Section 80.5.5).
Tip: Payers aren't limited to these frequency exceptions. Check your local coverage determination for your payer's
specifics.
Helpful hint: Physicians may order a DXA scan during a "Welcome to Medicare" exam. This test isn't part of the
exam, and Medicare should cover it separately.
Add This Osteopenia Tip to Your DXA Toolbox
You may see a DXA report for osteopenia. The ICD-9 manual index points you to 733.90 (Disorder of bone and
cartilage, unspecified) for osteopenia, which is lower than normal bone density that is not yet osteoporosis. Because
the patient has a history of osteopenia, this DXA is not a screening.

Check to see whether the test was to monitor drug therapy. According to CMS transmittal 1416, carriers cover DXA
tests used to monitor FDA-approved osteoporosis drug therapy every two years. But coverage applies only for 77080
(Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine])
coded with 733.0x (Osteoporosis), 733.90 (Disorder of bone and cartilage, unspecified), or 255.0 (Cushing's
syndrome).733.90 also includes borderline osteopenia.

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.