Coding and reimbursement issues for dual-energy X-ray absorptiometry.
Bone densitometry has a unique and invaluable place in the prevention, diagnosis, and management of osteoporosis. Dual-energy X-ray absorptiometry (DEXA) is currently considered the bone densitometric technique of choice. With this method, the patient at risk for osteoporosis can be identified so that appropriate clinical interventions to prevent fracture can be undertaken. DEXA also allows assessment of the efficacy of these interventions in preventing bone loss. As with any other technology, however, bone densitometry must be properly used in the clinical setting to achieve this benefit. Critical to the proper use of the technology is the realization that a complete assessment of fracture risk requires the measurement of both the spine and the proximal part of the femur, not either site alone, and that assessment of therapeutic efficacy might also require the measurement of both sites, not either site alone. Effective January 1, 1994, the Clinical Procedural Terminology (CPT) code for DEXA has been 76075. This code is intended for measurement of a single site and is to be reimbursed at a global rate of $60.85. Although the assignment of a CPT code for this clinically valuable technology is most welcome, the lack of a code reflecting at least two sites of study and the low rate of reimbursement for a single site suggest a misunderstanding of the actual costs of the technology and the need, on occasion, for measurements at multiple sites.
Sartoris
D J
DJ
Department of Radiology, University of California, San Diego, Medical Center 92103-8756.
D015502:Absorptiometry, Photon / Q000191:economics*; D000043:Abstracting and Indexing; D015914:Estrogen Replacement Therapy; D005260:Female; D005598:Fractures, Spontaneous / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007344:Insurance Claim Reporting / Q000191:economics*; D008499:Medical Records / Q000145:classification*; D016345:Medicare Part B / Q000191:economics*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011907:Rate Setting and Review; D015895:Relative Value Scales; D012307:Risk Factors; D014481:United States