Kypho coding

[Vie221]

Our Medicare guidelines are stating vertebral augmentation is only for patients with known osteoporosis. With DEXA missing up to 50 percent of these cases, how are you guys showing medical necessity and demonstrating known osteoporosis?

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[RoloTomassi]

I think the fact that they have a fragility fracture is enough, but not sure. Good question.

 

[lobelsteve]

Fx without trauma or with minimal trauma defines OP. Dexa is screening tool to determine risk of fx.

 

[Vie221]

Steve, I 100 percent agree with this and this is how I based my coding in the past. However, there is now a statement for “known osteoporosis” in the ICD.

M80.08XA states that it “should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone”

The only ACR diagnostic criteria is a DEXA with a T score under -2.5.

This is the issue. Do any of our societies have a position on this?

 

[callmeanesthesia]

Steve, I 100 percent agree with this and this is how I based my coding in the past. However, there is now a statement for “known osteoporosis” in the ICD.

M80.08XA states that it “should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone”

The only ACR diagnostic criteria is a DEXA with a T score under -2.5.

This is the issue. Do any of our societies have a position on this?

My interpretation of that is that you can use that code if they have a fragility fracture, regardless of the ACR criteria for osteoporosis.

 

[lobelsteve]

M80.08XA.
And I will just leave the ACE guidelines 2016 attached for those who need to send it to payors.

 

[Vie221]

Thanks! This helps a lot.