General Coding Guidelines for Osteoporosis

General Coding Guidelines for OsteoporosisOsteoporosis 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.

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