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Question: A patient presents to the office for screening DXA bone density test, but the order from her doctor states osteopenia and osteoporosis. Is this considered a screening, and what V code would we use for the diagnosis?

Codify Member

Answer: The answer depends on whether the order is saying "screening to rule out osteoporosis/osteopenia" or whether it's saying the patient has already been diagnosed with those, which would mean the test is no longer considered a screening.

Screening: If the physician ordered the exam before a diagnosis was made, you should consider this a screening. Report the DXA (for example, 77080, Dual-energy X-ray absorptiometry [DXA], bone density study, 1 or more sites; axial skeleton [e.g., hips, pelvis, spine]) and the screening diagnosis (V82.81, Special screening for osteoporosis). If there's a confirmed finding (such as osteopenia, 733.90, Disorder of bone and cartilage, unspecified), you should report the code for the finding as a secondary diagnosis.

Not a screening: This is not a screening if the ordering physician ordered the DXA scan because the patient had a previous DXA that showed osteopenia or osteoporosis. As a result coverage could be an issue. If the patient had a previous osteopenia diagnosis, check to see whether the test was to monitor drug therapy. According to Medicare Claims Processing Manual, Chapter 13, Section 140 (), carriers cover DXA tests every two years when used to monitor FDA-approved osteoporosis drug therapy.

Review the manual to get a view of national policies and then check your local payer policies for specific diagnosis code requirements.