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 patient’s 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 criteria’s–
- 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)
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. Let’s look at the codes –
- 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
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.
FAQs
Q: What is osteoporosis?
A: Osteoporosis is a bone disease that causes loss of bone tissue, making bones fragile and porous, which increases the risk of fractures.
Q: How is osteoporosis diagnosed?
A: Osteoporosis is diagnosed through a physical examination, medical history, and a Dual-energy X-ray Absorptiometry (DXA) bone density scan, which helps detect low bone mass.
Q: Does Medicare cover bone density tests?
A: Yes, Medicare Part B covers bone density tests every two years if the patient meets eligibility criteria such as being estrogen-deficient or taking steroid medications.
Q: What are the common CPT codes used for reporting osteoporosis?
A: Common CPT codes for osteoporosis include:
- 77080: DXA, bone density study (axial skeleton)
- 77081: DXA, bone density study (appendicular skeleton)
- 77085: DXA with vertebral fracture assessment.
Q: What is the difference between a traumatic and a pathologic fracture?
A: A traumatic fracture occurs due to an external force like accidents or falls, while a pathologic (non-traumatic) fracture is caused by a disease such as osteoporosis.
Q: How are fractures coded for osteoporosis?
A: For osteoporosis with a current pathological fracture, use M80-series codes, which specify the site, laterality, and episode of care (e.g., initial encounter, subsequent healing).
Q: When should M81-series codes be used?
A: M81-series codes should be used when the patient has osteoporosis without a current pathological fracture, even if there was a fracture in the past.
Q: Why is detailed documentation important for osteoporosis coding?
A: Detailed documentation helps ensure correct coding and reduces the risk of claim denials, ensuring optimal reimbursement for healthcare providers.
Q: How can outsourcing medical coding help with osteoporosis billing?
A: Outsourcing medical coding allows specialists to focus on patient care while ensuring that complex osteoporosis documentation and billing are handled accurately.
