How To Use CPT Code 77086

CPT 77086 describes the use of dual-energy X-ray absorptiometry (DXA) to assess the presence of vertebral fractures in a patient. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 77086?

CPT 77086 can be used to describe the evaluation of a patient for the presence of vertebral fractures using dual-energy X-ray absorptiometry (DXA). This code is used when a provider utilizes a DXA imaging machine with add-on vertebral fracture assessment software to assess the patient’s vertebrae for any fractures. The imaging limitations of DXA make it impractical for assessing fractures above the fourth thoracic vertebra or below the fourth lumbar vertebra.

2. Official Description

The official description of CPT code 77086 is: ‘Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA).’ It is important to note that CPT code 77086 should not be reported in conjunction with CPT codes 77080 and 77085.

3. Procedure

1. The provider uses a DXA imaging machine with add-on vertebral fracture assessment software.
2. The patient’s vertebrae are exposed to two different low dose X-ray beams with different energy levels in alternate pulses.
3. The add-on software specifically designed for identifying vertebral fractures helps the provider identify any fractures present.
4. The assessment is limited to the vertebrae between the fourth thoracic vertebra and the fourth lumbar vertebra.

4. Qualifying circumstances

CPT 77086 is used when a provider assesses a patient for the presence of vertebral fractures using DXA. This assessment is typically performed on patients who may have experienced trauma or have risk factors for vertebral fractures, such as osteoporosis. It is important to note that CPT code 77086 should not be reported in conjunction with CPT codes 77080 and 77085.

5. When to use CPT code 77086

CPT code 77086 should be used when a provider performs a DXA assessment specifically for the evaluation of vertebral fractures. It should not be used for general bone density studies or assessments of other skeletal sites. It is important to note that CPT code 77086 should not be reported in conjunction with CPT codes 77080 and 77085.

6. Documentation requirements

To support a claim for CPT code 77086, the provider must document the following information:

• Reason for the assessment, such as trauma or risk factors for vertebral fractures
• Use of a DXA imaging machine with add-on vertebral fracture assessment software
• Date of the assessment
• Specific vertebrae assessed
• Identification of any vertebral fractures
• Signature of the provider performing the assessment

7. Billing guidelines

When billing for CPT code 77086, ensure that the assessment is performed using a DXA imaging machine with add-on vertebral fracture assessment software. It is important to note that CPT code 77086 should not be reported in conjunction with CPT codes 77080 and 77085. Additionally, CPT code 77086 should only be reported once, even if the assessment involves multiple vertebral segments.

8. Historical information

CPT code 77086 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A provider uses DXA to assess a patient’s vertebrae for fractures following a fall.
2. A patient with osteoporosis undergoes a DXA assessment to evaluate the presence of vertebral fractures.
3. A provider performs a DXA assessment on a patient with multiple risk factors for vertebral fractures.
4. A postmenopausal woman undergoes a DXA assessment to assess her risk of vertebral fractures.
5. A patient who experienced trauma to the back undergoes a DXA assessment to evaluate for vertebral fractures.
6. A provider uses DXA to assess a patient’s vertebrae for fractures following a motor vehicle accident.
7. A patient with a history of osteoporotic fractures undergoes a DXA assessment to evaluate for additional vertebral fractures.
8. A provider performs a DXA assessment on a patient with chronic steroid use to assess for vertebral fractures.
9. A patient with a family history of vertebral fractures undergoes a DXA assessment to evaluate her risk.
10. A provider uses DXA to assess a patient’s vertebrae for fractures following a sports injury.