Coding for bone-density DEXA of hips and forearm

Q.

If we perform a bone density on the hips and forearm, can we submit both CPT^® code 77080 and CPT code 77081 together?

A.

Yes, you can. After saying for years that you could not code both, the American Medical Association (AMA) and the American College of Radiology (ACR) changed their policy in 2020. 

The Centers for Medicare& Medicaid Services (CMS) still had a policy in the 2020 NCCI policy manual that said you could only code for one procedure, but in transmittal 10193 released in June of 2020, CMS changed their policy: “Effective for claims received on and after 7/1/2020, CWF shall edit for -XU modifier to bypass CWF frequency edit as follows: attach to 77081 when both 77081 and 77085 are on a claim. Attach to 77080 when both 77080 and 77081 are on a claim.”

However, you should be aware that the 2021 NCCI policy manual still states the following:

“15. Axial bone density studies may be reported with CPT^® codes 77078 or 77080. Peripheral site bone density studies may be reported with CPT codes 77081, 76977, or G0130. Although it (Revision Date [Medicare]: 1/1/2021 IX-25) may be medically reasonable and necessary to report both axial and peripheral bone density studies on the same date of service, NCCI PTP edits prevent the reporting of multiple CPT codes for the axial bone density study or multiple CPT codes for the peripheral site bone density study on the same date of service.”

Please check with your MAC or watch for updated LCDs to find out how your MAC will process these claims.