Should a DEXA (Dual-Energy X-ray Absorptiometry) scan be ordered for osteoporosis screening using the appropriate ICD10 (International Classification of Diseases, 10th Revision) code?

DEXA Scan Ordering for Osteoporosis Screening: Appropriate ICD-10 Coding

DEXA scans for osteoporosis screening should be ordered using screening ICD-10 codes (Z13.820 for osteoporosis screening) rather than diagnostic codes, as this aligns with preventive care guidelines and ensures appropriate insurance coverage. 1

Appropriate Indications for DEXA Screening

Standard Screening Recommendations

• All women aged 65 years and older and men aged 70 years and older (asymptomatic screening) 1
• Women younger than 65 years with additional risk factors for osteoporosis, including:
  • Estrogen deficiency 1
  • Maternal hip fracture history after age 50 1
  • Low body mass (<127 lb or 57.6 kg) 1
  • History of amenorrhea (>1 year before age 42) 1

High-Risk Individuals Requiring Earlier Screening

• Individuals with medical conditions that alter BMD:
  • Chronic renal failure 1
  • Rheumatoid arthritis and inflammatory arthritides 1
  • Eating disorders 1
  • Organ transplantation 1
  • Prolonged immobilization 1
  • Conditions associated with secondary osteoporosis (gastrointestinal malabsorption, vitamin D deficiency, etc.) 1
• Individuals receiving (or expected to receive) glucocorticoid therapy for >3 months 1, 2
• Hypogonadal men older than 18 years 1
• Individuals beginning long-term therapy with medications known to adversely affect BMD 1
• Postmenopausal women on aromatase inhibitors 1
• Premenopausal women on tamoxifen and/or GnRH agonists 1
• Women with chemotherapy-induced premature menopause 1

ICD-10 Coding for DEXA Scans

Screening Codes

• Z13.820: Encounter for screening for osteoporosis 1
• Use this code for asymptomatic screening based on age or risk factors 1

Diagnostic Codes (When Appropriate)

• M81.0: Age-related osteoporosis without current pathological fracture
• M85.9: Disorder of bone density and structure, unspecified
• These should be used only when osteoporosis has already been diagnosed, not for initial screening 1

Follow-Up DEXA Scanning Recommendations

• Patients receiving treatment who demonstrate decreasing BMD may require adjustment in pharmacotherapy regimen 1
• Monitoring interval is typically 2 years for standard follow-up 1
• 1-year follow-up for patients initiating therapy or at risk for substantial short-term decreases in mineralization (e.g., glucocorticoid therapy) 1
• Scan intervals <1 year are discouraged 1
• Patients should be scanned on the same DXA scanner for accurate comparison 1

Common Pitfalls in DEXA Ordering

• Using diagnostic codes (M-codes) instead of screening codes (Z-codes) for initial screening may result in denied insurance claims 1, 3
• Ordering follow-up scans too frequently (less than 1 year apart) is not recommended as changes in BMD occur slowly 1
• Failure to use the same DXA scanner for follow-up studies can lead to inaccurate comparisons 1
• Underutilization of DEXA screening in high-risk populations leads to underdiagnosis and undertreatment 1, 4

Interpretation of DEXA Results

• Normal BMD: T-score greater than -1.0 1
• Osteopenia (low bone mass): T-score between -1.0 and -2.4 1
• Osteoporosis: T-score equal to or less than -2.5 1
• Z-scores (comparison to age-matched controls) should be used to detect secondary causes of osteoporosis 1, 2
• FRAX tool can be used for fracture risk assessment in patients with osteopenia 1, 5

By using the appropriate screening ICD-10 codes when ordering DEXA scans for osteoporosis screening, healthcare providers ensure proper insurance coverage while following evidence-based guidelines for early detection and prevention of osteoporotic fractures.