CPT code 77080, CPT 77080, 77080 CPT code, 77080

CPT Code 77080 | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 77080 is defined as a medical procedure code in the subject of bone/joint studies. Bone Mass Measurement (BMM) can cover by dual-energy x-ray absorption spectroscopy as a method of monitoring osteoporosis medication therapy.

Medicare will reimburse all ICD-10-CM diagnoses recognized as appropriate by medicare contractors for bone mass measurements for procedure code 77080.

In addition, beginning January 1, 2007, Medicare will cover osteoporosis medication therapy tracking with dual-energy x-ray absorption BMM for CPT code 77080. 

By removing single-photon coverage, it altered the meaning of BMM. Researchers examine variations in bone density over time to identify the severity of bone illnesses and the effectiveness of treatment. 

The link between bone mass and degenerative disorders can diagnose with this CTP code 77080.

CTP code 77080 can use for the following:

  1. Diagnose the disease.
  2. Monitor bone changes as the disease advances.
  3. Monitor bone changes as a result of treatment; the bone disease can need a variety of single or combined assessment techniques. 

When a practitioner uses DEXA or DXA to assess vertebral fracture risk or to measure the number of minerals in the skeleton, CPT codes 77080, 77081, 77085, and 77086 can use to report services.

TIP: You can find the DEXA Scan CPT Codes billing guide here.

Many chronic bone illnesses, including lupus, diabetes, rheumatoid arthritis, and other organ diseases, can affect bone degradation.

In addition, osteoporosis is one’s family, old age, and previous fractures or accidents resulting in bone density loss can all negatively impact bone density. DEXA CPT codes can be used for screening, evaluating therapy, and diagnosing.

77080 CPT Code Description

The official description of CPT code 77080, as described by the CPT manual, is: “Dual-energy X-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (eg, hips, pelvis, spine).”

When the two are performed combined, the CPT code for a hip, pelvis, and spine DEXA study is 77080, and the CPT code for a vertebral fracture assessment is 77085.

CPT code 77081 can use to bill for treatment on the wrists or heel bones. When doctors are just examining a spinal fracture, they frequently utilize CPT number 77080. 

The billing guide for all CPT codes for DEXA can be found here.

When a doctor performs a dual-energy X-ray absorptiometry examination of the axial skeleton, the CPT code 77080 is used (such as the hips, pelvis, and spine).

A dual-energy X-ray absorptiometry system (axial skeleton) can use to assess the efficacy of an FDA-approved osteoporosis drug therapy for a specific individual patient in the case of CTP code 77080.

The medicare procedure code 77080 only refers to the evaluation of vertebral fractures, according to the government program.

You can bill the appropriate bone density study, such as 77080 (for example), in addition to the 77082 code for the vertebral fracture assessment because the latter is not an accurate representation of the BONE density study.

Because of the medical setting, the documents must be relevant and demonstrate the need for the service.

For reimbursement, ICD 10 codes are required and can document claims. The most often used diagnosis codes are Z13.820, M81.0, and M85.89.

CPT codes 77080, 77081, 77085, and 77086 have both technical and professional elements. As a result, the appropriate 26 or TC adjustment must need. The TC and 26 changes are unnecessary if the doctor is the sole owner of the practice.

Billing Guidelines Of CPT Code 77080

On the same day of service, the CPT codes 77080 and 77081 for DEXA scans can bill together with the appropriate modifier.

However, Medicare can only cover the initial bone mass measurement once, regardless of the number of study locations (e.g., if the spine and hip are studied, CPT code 77080 can bill only once).

Every claim must include diagnosis codes that accurately describe the patient’s condition and the reason(s) for the service’s provision.

In addition, to be considered a “qualified individual,” a patient’s medical records must attest that they meet one of the following criteria. 

Documentation must be available on demand and as needed. It is the provider’s responsibility to code their services to the greatest extent possible. Service is not always covered simply because a diagnosis code can use correctly. 

The service must meet the following criteria to be considered acceptable: Doctors will disregard any BMM tests that do not come with an explanation and report. In addition, DEXA CPT codes 77080 and 77085 cannot charge on the same day. 

The DEXA CPT 77086 and CPT 77080 codes cannot charge on the same service day. Because of the increased payment, only CPT code 77085 will report. However, if the appropriate modifier can use, CPT code 77081 can bill alongside CPT code 77085. 

Because of the more significant incentives, only CPT 77080 will record. In addition, Medicare will not pay for BMM tests performed by a second provider unless they are confirmatory tests for future monitoring if one has already been completed within the defined coverage period, as stated above. 

Prior test results can obtain with the patient’s consent. If there is an attempt at new tests, consider if previous test results from a different provider will document.

It is not permissible to bill CPT code 77086 and DEXA scan CPT 77085 on the same date. Because of its higher remuneration, only CPT 77085 will disclose.

When billing simply for the technical component, the TC modifier must be attached to the procedure code/HCPCS code.

For example, Medicare interprets CPT code 77080 to only refer to the evaluation of vertebral fractures. To bill for screening purposes, code 77082 can avoid. 

This code can b charged when medically necessary (i.e., when a vertebral fracture assessment is required). Assume that the tests’ results can use in the patient’s care and document any symptoms the patient can have.

Modifiers

CPT codes 77080 can use modifiers like 26, TC, 77, 76, 59, or X E, P, S, U.

When a doctor provides care in a hospital but does not own or work at the facility, modifier 26 applies to CPT codes 77080 – 77086.

Even though the TC modifier can intend to designate technical characteristics such as MRI Cervical spine equipment, it can use to represent other CTP codes like 77080.

The owner of the equipment, whether a hospital or another organization, can file a complaint; if the services will provide in a doctor’s private office or if the doctor owns the equipment, CPT codes 77080 – 77086 will bill. When the 26th or TC modifier can not utilize, it is called “global billing.”

Modifier 76 records CPT codes 77080 to 77086 when one doctor performs the same treatment twice on the same day, while Modifier 77 reports the same service done by a different doctor.

When two or more services are generally conducted on separate service days but can merge with additional procedures, the CPT modifier 59 is applied. When used with CPT codes 77080-77086, Medicare accepts modifiers XU, XE, XP, and XS instead of modifier 59.

Modifier Q6 can use for billing locum tenens or substituting physicians for CPT code 77080. Consider that the radiologist can be out of the office or on vacation.

In the case of mass bone measurement, several modifiers can use to help the physician and patient in their reimbursement cases.

When a physician conducts some procedures, CPT codes 77080 – 77086 will assign modifier 52.

Modifier 53 can use by doctors to indicate that they have discontinued an approach but intend to restart it in the future. Codes 77080-77086 fall within this category.

If an Independent Diagnostic Testing Facility (IDTF) provides worldwide service at a location other than its own, the site where the service can deliver must be the same as the location where the service can invoice for the claim. 

Reimbursement

Only one unit can be invoiced for CPT codes 77080 to 77086 on the same service date. CPT 77080 – 77086 pricing and RUVS are as follows:

CPT 77080 – CPT77086, in addition to modifier 26, are eligible for reimbursement. The facility costs RUVS 0.29942 (about $10.36). The cost of not having a facility is RUVS 0.29942.

The facility costs $33.20 RUVS 0.95932 per hour in the CPT 77080-77086 TC (Technical Component) Modifier range. Non-facility costs 33.20 RUVS 0.95932 RUB.

CPT 77080 – CPT 77086: Costs in other nations (except 26 and TC) worldwide. The total cost of the facility was $4.66701. The cost of not using the facility is $43.56 RUVS 1.25874.

Example 1

A 35-year-old bodybuilder arrives at the doctor’s office. After two weeks of weight training, his hands became numb and tingly.

Every day, his condition worsens, and he now has bodily aches. Finally, the doctor conducted a DEXA scan of both hands, which revealed an extremely high bone density. Despite the patient’s use of steroids, osteoporosis does not run in the family.

CPT code 77080 can be billed in this case.

Example 2

The 77080 CPT code can be reported in the following case.

For 72 years, an old patient has experienced intermittent pain for two hours. There is no evidence that he has recently been in contact with anyone who has been sick or experienced symptoms such as near-syncope or syncope.

He also denies having any symptoms like back pain, abdominal pain, nausea, recent travel, changes in stool color, or any other. 

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