Musculoskeletal conditions, such as osteopenia, osteoporosis, arthritis, and soft tissue injuries, are quite common among U.S. citizens. As a matter of fact, they affect more than one out of every two persons who are 18 or older in the country. That’s why bone and joint studies, including bone densitometry, are quite popular.
But how do you bill for this most thoroughly used bone mineral density (BMD) examination? There are several coding options, including CPT code 77080. The ultimate choice depends on the focus of the test. Let us take a clear look at the 77080 CPT code to see what it covers and how it is used in the real world.
CPT Code 77080 – Description
So, what does this code represent? CPT code 77080, as we mentioned at the start, defines dual-energy X-ray absorptiometry (DXA). This imaging procedure is also known as bone densitometry. Healthcare providers specifically use this code to bill for a non-invasive scan of one or more bony areas on the trunk.
The primary purpose of DXA is to determine a patient’s bone health by measuring their bone mineral density. You can also use the 77080 CPT code if you have performed the test to determine whether a patient has osteopenia or osteoporosis.
Appropriate Use Cases for CPT Code 77080
For accurate billing and reimbursements, explore the following scenarios of CPT code 77080:
Billing a DXA Scan for Osteoporosis
Osteoporosis increases the risk of fractures. Unfortunately, 10 million Americans have this disease. Since several conditions increase the risk of osteoporosis, let’s consider a middle-aged woman with rheumatoidarthritis.
She arrives at a hospital after slipping and breaking her hip. The fracture is due to a minor fall. Therefore, the healthcare provider suspects reduced bone density and performs a DXA scan of the axial skeleton. He then uses CPT code 77080 to bill for this imaging study.
Monitoring Bone Density of An Osteopenia Patient
Osteopenia is another common condition that affects bone density. It is present in half of Americans who are older than 50. Therefore, let’s suppose an older man with osteopenia is following the suggested treatment, that is, physical activity and taking calcium and vitamin D supplements, for 2 years.
He visits his healthcare provider for a routine checkup. To monitor his progress, the radiologist performs a dual-energy X-ray absorptiometry of the spine and hip to determine his bone mineral density. He then reports this service with CPT code 77080.
Modifiers to Append with CPT Code 77080
This code includes both professional and technical components of DXA. To avoid payment delays, always specify the details of any imaging study. You can do that by applying one of the following modifiers to CPT code 77080:
Modifier TC
If you are only billing for the use of the equipment, administrative costs, and staff support during bone densitometry, append modifier TC to CPT code 77080.
Modifier 26
To report a physician’s interpretation of DXA, use modifier 26 with CPT code 77080. This modifier highlights the professional component of a service, including a written report.
Reimbursement Guidelines for CPT Code 77080
You must follow these guidelines for using CPT code 77080 correctly:
Report DXA Scan of Axial Skeleton with 77080
Many healthcare professionals get confused because CPT code 77080 is quite similar to 77081. However, they have a slight difference. You must only use the 77080 CPT code if you performed a DXA scan of the axial skeleton, that is, the hips, pelvis, and spine. Hence, avoid using it to bill for measuring bone mineral density of the appendicular skeleton (wrist, heel, or forearm).
Understand this Code’s Billing Frequency
You cannot bill for DXA whenever you want. Many payers, including Medicare, may limit the use of CPT code 77080. According to Medicare, you can only bill for the initial bone mass measurement once, regardless of the studied sites. For example, if you have performed a DXA scan to examine the hips and spine, you must bill 77080 only once.
Justify Your Claim with Complete Documentation
Don’t expect payment without justifying the medical necessity of bone densitometry. Before performing this scan, confirm whether the test is for measuring the BMD of the axial or appendicular skeleton. Then, completely document the procedure. This includes recording the following details:
- Detailed evaluation
- Clinical reason for DXA scan (screening for osteopenia or osteoporosis in high-risk patients)
- Relevant medical history
- Test results and findings
Avoid Basic Mistakes
Our last advice is to avoid common mistakes. This includes filing a claim for an unnecessary DXA scan or using CPT code 77080 to bill for a repeat test performed by another provider. You must also make sure to review payer-specific guidelines to submit a clean claim.
Final Thoughts on CPT Code 77080
And there you have it: a comprehensive guide on CPT code 77080. We hope that by now you understand this code and its implications thoroughly. To summarize, 77080 refers to a simple imaging test to measure bone mineral density. To be more specific, it covers a dual-energy X-ray absorptiometry of the axial skeleton.
We understand how important it is for every healthcare professional to meet the documentation requirements and billing guidelines of this code. Therefore, we have covered all the important details in our blog. You can follow our step-by-step guidelines to receive timely reimbursements. But if our instructions seem difficult to follow, you can always opt for our radiology billing services.
