Updated DXA Policy for Medicare Patients

March 6, 2017

Medicare covers DXA Bone Densitometry for certain Medicare beneficiaries who fall into at least one of the following categories:

1.) A woman whose doctor has determined she’s estrogen-deficient and at a clinical risk for osteoporosis, based on her medical history and other findings.

2.) Patient with vertebral abnormalities as demonstrated by x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.

3.) Patient receiving or expecting to receive glucocorticoid (steroid) therapy equivalent to an average of 5.0mg of prednisone, or greater per day for more than 3 months.

4.) Patient with primary hyperparathyroidism.

5.) Patient being monitored to assess their response to or efficacy of an FDA-approved osteoporosis drug therapy.

Medicare beneficiaries who meet the above criteria may have a Diagnostic DXA once every 24 months (more often if medically necessary).

In addition to the many ICD-10 codes for fracture, the following diagnosis codes, when used with a DXA Bone Scan (77080) will be accepted and paid by Medicare:

Z78.0 Asymptomatic menopausal state
Z79.3 Long term (current) use of hormonal contraceptives
Z79.51 Long term (current) use of inhaled steroids
Z79.52 Long term (current) use of systemic steroids
Z79.83 Long term (current) use of bisphosphonates
Z87.310 Personal history of (healed) osteoporosis fracture

Please note – Medicare will deny any claim that says “Screening DXA Bone Density” without any other indication and your patient will have to sign an ABN and pay out of pocket.  

If you have any questions, please do not hesitate to contact us at 609.921.8211.

Princeton Radiology Collaborates with Local Urologists to Offer The Next Generation in Prostate Care

Princeton Radiology has acquired UroNav software by Invivo. With this new software we are able to gather pre-biopsy MRI images of the prostate and then seamlessly transfer them to local Urologists. Using UroNav, these Urologists can fuse the pre-biopsy MRI images with real time ultrasound-guided biopsy images for excellent delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle – allowing Urologists to directly aim biopsy needed at lesions. Better images means better results.

Prostate cancer is the only type of solid organ tumor that is usually diagnosed sight unseen with hit-or-miss tissue biopsies.

For decades, Urologists have used a systematic, but blind approach to sample prostate tissue in men with an elevated PSA level and no palpable lesion, taking up to 18 core needle biopsies in scattered sections of the organ. Using this method doctors can’t be sure that they haven’t missed an aggressive tumor hidden in the 99% of tissue that was not biopsied, and they sometimes end up sticking needles into men who have no tumors, only an elevated PSA level.

Now, due to the precise targeting provided by MRI, many fewer biopsy samples are needed for accurate diagnosis – sometimes 80 to 90% fewer.  Fewer needle-sticks means lower risk of infection, bleeding, pain, and means and shorter recovery time. And thanks to the recent advance called multi-parametric MRI, specially trained radiologists can gauge the aggressiveness of a prostate lesion not only by how it looks, but also by how tightly its cells are packed, how blood flows through it, and its chemical makeup.

Targeted MRI/Ultrasound biopsy is poised to become the new standard in prostate cancer detection. Princeton Radiology is proud to collaborate with local Urologists to bring the next generation of prostate care to our patients.

Prostrate Care

Image: Magnetic resonance (MR)/ultrasound fusion combines MR images of the prostate (bottom left, red line) with real-time ultrasound images of the prostate (top left, red line) to assist in targeted biopsy of a previously identified lesion (green line). The location of the biopsy can be recorded (yellow line), and a reconstructed 3-dimensional map of the prostate can be generated at the conclusion of the biopsy (right). Standard biopsy cores and targeted biopsy cores are highlighted here for comparison.