Ordering Bone Density exam under Medicare

[Guest guest]

I have a 57 yr old patient who has been on steroids for lupus for

15 years – 7.5 mg per day; had a hysterectomy at age 30 because of

excessive bleeding. No HRT post procedure. She has had a fractured

elbow following striking it on a doorway while on vacation. She also had

a stress fracture in her foot a year ago while participating in the breast

cancer walk with her daughter who had breast CA.

I figured even though she was under 60 the 2 broken bones and long

term history of steroid use and premature menopause and lack of estrogen since

age 30 made her a hands down candidate for a DEXA bone scan. I coded the

request with 733.94 – Stress Fracture Metatarsals; 256.31 premature

menopause and V58.65 long term use of steroids and requested a screening bone

scan. Two local hospitals are claiming that I can’t order CPT 77080

with the above 3 diagnosis codes. They claim Medicare won’t pay for

the test. With those diagnosis codes and are refusing to schedule the

test if we don’t add a 733.xx code to the order. I have spent the

day checking out different Medicare and Cahaba documents related to bone density

screening. I say I am right and I should be able to order a screening

test to check for a suspected condition with the diagnosis I listed without

having to add an osteoporosis diagnosis to the test order just to get the

hospital to take the order.

Somebody please help me resolve this issue.

Beth Sullivan, DO

Clinical Administrator

Ridgeway Family Practice

Commerce, GA 30529