We have many referring physicians ordering bone density exams (77080) with the diagnosis of Z13.820 (encounter for screening of osteoporosis). The claims for these are being denied by Medicare with the message “non-covered routine exam.” Doesn’t Medicare pay for a screening bone density scan every two years? Show Answer: Answer: Medicare does not cover or reimburse a true screening bone density exam. Medicare covers bone density exams only when the patient has documentation of one of the five qualifying circumstances listed below: (1) A woman who has been determined by the physician (or a qualified nonphysician practitioner) treating her to be estrogen-deficient and at clinical risk for osteoporosis, based on her medical history and other findings (2)An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture(3) 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(4)An individual with primary hyperparathyroidism(5)An individual being monitored to assess the response to or efficacy of an FDA-approved osteoporosis drug therapyThe diagnosis code you report must indicate one of the above qualifications. Medicare will always deny Z13.820 if it is the primary or only diagnosis code. The Medicare national coverage determination (NCD) can be found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1580OTN.pdf. Additional diagnoses for osteopenia that were left out of the original NCD file can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1525.pdf. Medicare covers DXA Bone Densitometry for certain Medicare beneficiaries who fall into at least one of the following categories: 1.) A woman whose doctor has determined she’s estrogen-deficient and at a clinical risk for osteoporosis, based on her medical history and other findings. 2.) Patient with vertebral abnormalities as demonstrated by x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture. 3.) Patient receiving or expecting to receive glucocorticoid (steroid) therapy equivalent to an average of 5.0mg of prednisone, or greater per day for more than 3 months. 4.) Patient with primary hyperparathyroidism. 5.) Patient being monitored to assess their response to or efficacy of an FDA-approved osteoporosis drug therapy. Medicare beneficiaries who meet the above criteria may have a Diagnostic DXA once every 24 months (more often if medically necessary). In addition to the many ICD-10 codes for fracture, the following diagnosis codes, when used with a DXA Bone Scan (77080) will be accepted and paid by Medicare: "Present On Admission" is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA.
Convert Z13.820 to ICD-9-CM
ICD-10-CM Codes Adjacent To Z13.820 Z13.6 Encounter for screening for cardiovascular disorders Z13.7 Encounter for screening for genetic and chromosomal anomalies Z13.71 Encounter for nonprocreative screening for genetic disease carrier status Z13.79 Encounter for other screening for genetic and chromosomal anomalies Z13.8 Encounter for screening for other specified diseases and disorders Z13.81 Encounter for screening for digestive system disorders Z13.810 Encounter for screening for upper gastrointestinal disorder Z13.811 Encounter for screening for lower gastrointestinal disorder Z13.818 Encounter for screening for other digestive system disorders Z13.82 Encounter for screening for musculoskeletal disorder Z13.820 Encounter for screening for osteoporosis Z13.828 Encounter for screening for other musculoskeletal disorder Z13.83 Encounter for screening for respiratory disorder NEC Z13.84 Encounter for screening for dental disorders Z13.85 Encounter for screening for nervous system disorders Z13.850 Encounter for screening for traumatic brain injury Z13.858 Encounter for screening for other nervous system disorders Z13.88 Encounter for screening for disorder due to exposure to contaminants Z13.89 Encounter for screening for other disorder Z13.9 Encounter for screening, unspecified Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. What ICD 10 code covers DEXA scan for Medicare?ICD 10 diagnosis for bone density DEXA scan CPT code 77080 and 77081.
What is the 2022 ICD 10 code for osteoporosis?The billable ICD 10 code for osteoporosis, unspecifed is M81. 0, it is mainly used in coding DEXA scan or bone density scan procedure codes. Osteopenia and Osteoporosis are the main diagnosis used for coding DEXA scan exams.
What is the code for bone density screening?Group 1. What is the CPT code for osteoporosis screening?Patients who qualify by statute for osteoporosis screening may be evaluated by studies that are characterized by CPT codes 77078, 77080, 77081, 77085, 76977, and G0130. The following is a list of ICD-10-CM codes that support the medical necessity of osteoporosis screening.
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Icd 10 code for osteoporosis screening for medicare
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