We have been ordering more bone density screenings for our male patients. So far all have come back with some degree of low-bone density and coverage has not been an issue. However one recent screen in a 69 year-old was completely normal and Medicare is declining coverage. We typically use dx codes B20 and Z79.899. Any pearls on getting the test covered?
Hi Jennifer, that sounds terrible (almost like they'll pay for it only if the results show some degree of low-bone density??). Does the patient have history of chronic TDF use? If so, I think that would be a reason to get it covered. I'm wondering about contacting Medicare for a peer-to-peer (not sure how that works for screenings though as I've only really done for medications).
If those don't work, there is an ECHO (telemedicine for clinicians, via Zoom) specifically on Bone Health on Tuesdays from 2-3pm ET. While it is not specific to people with HIV, I think it would be worth presenting a de-identified case and ask the team of experts their thoughts and possible tips! I'm sure they would be able to review labs and other clinical information to help navigate Medicare pushback.
I have had success using Z79.624 - Long term (current) use of inhibitors of nucleotide synthesis
I found this in the pop up on my Epic build of Medicare approved associated diagnoses for DEXA scan that comes up when I don't use a covered diagnosis.
Hope that helps!