Northwest Region, USA
Q. How often will Medicare pay for DXAs?
A. Medicare will reimburse for DXAs once every two years with a few exceptions, as long as the patient meets appropriate criteria for screening DXAs, reviewed in a prior issue of OsteoFlash® (November 2004). A DXA may be repeated one year after initiation of therapy, although this one year interval is only paid once. A DXA may be repeated within six months if an individual is receiving corticosteroid therapy (greater than three months, on the equivalent dose of 7.5 mg of prednisone or greater per day). Editor’s note: There may be variations on these generalizations and each practitioner should check with his or her own Medicare region’s insurance carrier.
Q. Are there guidelines for how a DXA report should be dictated?
A. The ISCD has issued a position statement detailing guidelines for DXA reports link here.
South Central Region, USA
Q. What are the requirements for a DXA technologist in my state?
A. A listing of state regulations for bone densitometry state regulations can be found through a link on the Resources page of this Web site.
Q. Would you please assist me in providing an ICD-9 code for a patient that we do not know if they have osteoporosis but they are currently taking steroids. Basically, how do you code a baseline bone density and get reimbursed for your services.
A. There is a v-code for monitoring of long-term steroid therapy (v 58.65). Thus, if I am seeing a patient for rheumatoid arthritis (RA) and I perform a DXA because of chronic corticosteroid therapy, the coding would be 714.0 (RA) v 58.65 (monitoring long-term steroid therapy).
Q. We have two sites where the technologists do not at all request removal of a bra. In 90% of spine BMDs from those two sites, I see metal bra clips and sometimes underwires showing at T12. Is it correct to say that the proper technique for technologists is to always request removal of a bra? Also, does it still matter if the bra is there, if neither the metal clips nor the underwires are overlying L1 ROI (i.e., they are restricted to the T12 area)?
A. You do not necessarily have to remove it entirely but at least undo the hooks and place them to the sides away from the centre. The underwire should be moved up over the breast so it doesn’t get in the field of view (FOV). Are they sure that the hooks are only on T12? You may not see them if they are overlying the vertebrae. Having metal in the FOV may interfere with the tissue uptake, which will interfere with the BMD.
Last modified: December 17, 2012