How To Use HCPCS Code G8861

HCPCS code G8861 describes the use of central dual-energy x-ray absorptiometry (DXA) within the past 2 years, along with a review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed. This code is used to identify and bill for the specific services provided in relation to osteoporosis management and treatment.

1. What is HCPCS G8861?

HCPCS code G8861 is a specific code used in medical coding to identify and bill for the services related to osteoporosis management. It signifies that a central dual-energy x-ray absorptiometry (DXA) scan has been ordered and documented, along with a review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed. This code helps healthcare providers accurately report and track the services provided for osteoporosis patients.

2. Official Description

The official description of HCPCS code G8861 is as follows: “Within the past 2 years, central dual-energy x-ray absorptiometry (DXA) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed.” The short description for this code is “DXA ordered for osteo.”

3. Procedure

1. The healthcare provider orders a central dual-energy x-ray absorptiometry (DXA) scan for a patient with suspected or diagnosed osteoporosis.
2. The provider documents the order for the DXA scan, along with a review of the patient’s systems and medication history or pharmacologic therapy for osteoporosis (excluding minerals/vitamins).
3. The DXA scan is performed, capturing images of the patient’s bones to assess bone density and detect signs of osteoporosis.
4. The results of the DXA scan are reviewed and interpreted by the healthcare provider.
5. Based on the findings of the DXA scan and the patient’s medical history, the provider may prescribe pharmacologic therapy or recommend further interventions for osteoporosis management.

4. When to use HCPCS code G8861

HCPCS code G8861 should be used when all the following criteria are met:

• A central dual-energy x-ray absorptiometry (DXA) scan has been ordered and documented within the past 2 years.
• A review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis has been conducted.
• The DXA scan and associated services are specifically related to the management and treatment of osteoporosis.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G8861, healthcare providers need to ensure proper documentation of the following:

• The order for the central dual-energy x-ray absorptiometry (DXA) scan.
• The documentation of the review of systems and medication history or pharmacologic therapy for osteoporosis.
• The results and interpretation of the DXA scan.
• Any additional services or interventions provided for osteoporosis management based on the DXA scan results.

Providers should follow the specific billing guidelines and requirements of the payer, such as Medicare or private insurance, to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G8861 was added to the Healthcare Common Procedure Coding System on January 1, 2012. It has an effective date of January 1, 2020. As of December 31, 2019, this code has been terminated and is no longer in use. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage and reimbursement for HCPCS code G8861 may vary depending on the payer, such as Medicare or private insurance. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered by Medicare. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G8861 is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G8861 should be billed:

1. A 65-year-old female patient with a history of osteoporosis visits her primary care physician. The physician orders a DXA scan and reviews the patient’s medication history for osteoporosis. The DXA scan is performed, and the results indicate a need for pharmacologic therapy. HCPCS code G8861 should be billed for this encounter.
2. A 70-year-old male patient is referred to a specialist for osteoporosis management. The specialist orders a DXA scan and reviews the patient’s systems and medication history related to osteoporosis. The DXA scan shows significant bone density loss, and the specialist prescribes pharmacologic therapy. HCPCS code G8861 should be billed for this encounter.
3. A 55-year-old female patient presents to an orthopedic clinic with a recent fracture. The orthopedic surgeon orders a DXA scan and reviews the patient’s medication history for osteoporosis. The DXA scan reveals osteoporosis, and the surgeon recommends pharmacologic therapy. HCPCS code G8861 should be billed for this encounter.
4. A 75-year-old male patient undergoes a routine annual physical examination. The primary care physician orders a DXA scan and reviews the patient’s systems and medication history for osteoporosis. The DXA scan shows normal bone density, and no further interventions are required. HCPCS code G8861 should be billed for this encounter.
5. A 60-year-old female patient visits a rheumatologist for ongoing management of osteoporosis. The rheumatologist orders a DXA scan and reviews the patient’s systems and medication history related to osteoporosis. The DXA scan reveals stable bone density, and the rheumatologist continues the current pharmacologic therapy. HCPCS code G8861 should be billed for this encounter.