General Coding Guidelines for Osteoporosis

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General Coding Guidelines for Osteoporosis
Osteoporosis is a bone disease that involves
abnormal loss of bony tissue resulting in fragile
or porous bones. Without appropriate treatment,
osteoporosis can worsen. As bones get weaker and
thinner, the potential risk for fractures
increases. Documentation is very important and
physicians must ensure timely medical
documentation to ensure appropriate treatment for
these patients. Medical billing and coding for
osteoporosis is complex and in order to meet
these documentation needs, most healthcare
practices depend on medical coding outsourcing.
Outsourcing these tasks will help specialists
reduce documentation work and focus more on
patient care.   Diagnosing osteoporosis condition
involves physicians reviewing patients
individual signs and symptoms, previous medical
history and conducting a detailed physical
examination to confirm the same. A dual-energy
X-ray absorptiometry (DXA or DEXA) bone density
scanning is the most standard screening tool for
diagnosing this condition. This screening test
helps to determine whether the patient has low
bone mass (meaning whether bones are weaker than
normal) and is likely to develop osteoporosis.
This, in turn, can help physicians to provide the
necessary treatment. Medicare Part B provides
coverage for bone density test, or bone mass
measurement test, once every two years, provided
the patient meets the following eligibility
criterias
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General Coding Guidelines for Osteoporosis

• Estrogen-deficient woman
• X-ray demonstrating osteopenia or vertebral
  fractures in the spine
• Intake of steroid medications or treatments
• Diagnosed with primary hyperparathyroidism
• Currently on osteoporosis prescription drug
  therapy
• Medical Codes for Reporting Osteoporosis 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)
• 77080 Dual-energy X-ray absorptiometry (DXA),
  bone 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)
• 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
• 77086 Vertebral fracture assessment via
  dual-energy X-ray absorptiometry (DXA)
•  

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General Coding Guidelines for Osteoporosis

• HCPCS Code
•  
• G0130 Single-energy x-ray absorptiometry (SEXA)
  bone density study, one or more sites
  appendicular skeleton (peripheral) (e.g., radius,
  wrist, heel)
• Osteoporosis with Fractures
• Fracture coding has become increasingly more
  specific when it comes to ICD-10 codes.
  Healthcare providers need to document, whether
  the fracture is traumatic or pathologic
  (non-traumatic). A traumatic fracture is one
  which is caused by accidents, falls or other
  kinds of force. On the other hand, fractures
  caused by disease, not trauma, are classified as
  pathologic (non- traumatic) fractures. Other
  prominent information to include when documenting
  a fracture is site of the fracture. This
  includes not only which bone is broken, but also
  the specific location of the fracture on the
  bone. Coders must include details such as distal
  end or proximal end.
• A code from M80- Series should be reported if the
  patient who visits physicians office has a
  current pathological fracture during the time of
  the encounter. The codes should be selected
  according to the site of the fracture, not the
  location of the osteoporosis. The laterality
  (right/left) should also be considered. Lets
  look at the codes

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General Coding Guidelines for Osteoporosis

• M80 Osteoporosis with current pathological
  fracture
• 0 Age-related osteoporosis with current
  pathological fracture
• 00 Age-related osteoporosis with current
  pathological fracture, unspecified site
• 01 Age-related osteoporosis with current
  pathological fracture, shoulder
• 011 Age-related osteoporosis with current
  pathological fracture, right shoulder
• 012 Age-related osteoporosis with current
  pathological fracture, left the shoulder
• 019 Age-related osteoporosis with current
  pathological fracture, unspecified shoulder
• M80-series codes also require a seventh character
  to specify episode of care, such as
• A Initial encounter for fracture
• D Subsequent encounter for fracture with routine
  healing
• G Subsequent encounter for fracture with delayed
  healing
• K Subsequent encounter for fracture with
  nonunion
• P Subsequent encounter for fracture with
  malnutrition
• S Sequela

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General Coding Guidelines for Osteoporosis

• Osteoporosis without Current Pathological
  Fracture
• If the patient does not have a current
  pathological fracture, a code from M81-series
  should be selected (even if the patient had a
  pathological fracture in the past). The codes in
  this series include
• M81 Osteoporosis without current pathological
  fracture
• 0 Age-related osteoporosis without current
  pathological fracture
• 6 Localized osteoporosis Lequesne
• 8 Other osteoporosis without current pathological
  fracture
• Orthopedic medical coding (particularly injury
  coding) in ICD-10 codes demands much more precise
  descriptions of the site of an injury. As a
  result, physicians need to provide more detailed
  documentation. With the support of an experienced
  medical billing and coding company,
  the physicians working in this specialty can
  submit their claims with up-to-date codes. This
  is crucial to avoid claim denials and ensure
  optimal reimbursement.