How to report bone mass measurement cases
A physician may order a bone mass measurement (BMM) study to identify:
- Bone mass
- Detect bone loss or
- Determine bone quality in a patient.
Bone Mass Measurement is performed with either a bone densitometer other than single-photon or dual-photon absorptiometry or a bone sonometer system.
Medicare covers screening Bone Mass Measurement once every 2 years (or more if medically necessary) under the following conditions :
- Is ordered by the physician or qualified Non-physician practitioner who is treating the beneficiary following an evaluation of the need for a Bone Mass Measurement and determination of the appropriate Bone Mass Measurement 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.
- 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 system (axial skeleton).
Coding for Bone Mass Measurement:
Bone Mass Measurement claims for dual-energy X-ray absorptiometry ,CPT(R) 77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) are reimbursable when this procedure is used to monitor osteoporosis drug therapy.
A physician?s interpretation of the Bone Mass Measurement results and a valid diagnosis code (e.g., M85.8- Other specified disorders of bone density and structure) must also be reported, indicating the reason for the test is for a postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.
New Guidelines for 2016
The Centers for Medicare & Medicaid Services (CMS) implemented Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. This CR established the list of covered conditions and corresponding ICD-10-CM diagnosis codes approved for Bone Mass Measurement studies according to the National Coverage Determination (NCD) 150.3. However, CR9252 and the accompanying spreadsheet inadvertently omitted the condition of osteopenia and the ICD-10-CM codes that describe it, which are classified to subcategory M85.8-.
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