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Be prepared with these 5 tips on orders, frequency, coverage, and more.

Prednisone may be helpful for reducing inflammation and its related pain in cancer patients, but it can also lead to bone loss. If your practice provides bone mass measurement (BMM) services for Medicare patients, these 5 tips should help keep your claims compliant.

1. Verify Order Is From a Qualified Provider

For Medicare to cover BMM, the test must be ordered by a physician or qualified nonphysician provider (NPP), according to Medicare Benefit Policy Manual (MBPM), Chapter 15, Section 80.5.4 ().

Practical solution: Some practice management software and/or EMR programs have some type of 'reminder' or patient notice feature. It often can be set up to either create a report with patient contact information or even send out automatic notices to the patients that meet the criteria for the specific reminder notice, i.e., immunizations, preventive services, or any other screening testing, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver, Colo.

For practices that don't have that type of software feature or haven't shifted to an EMR, some may consider using two 12-month accordion file folders or a recipe box with dividers for each of the 24-month periods, Hammer says. File the patient's contact information based on the month and year when the next screening test is allowed. For example, if a patient had the bone mass measurement screening in June 2012, the patient's information would be placed in the June 2014 slot. Then pull the information in May of 2014 to review which patients will be eligible for the diagnostic test the next month and either notify them to make an appointment or, if the patient has an appointment already scheduled, mark it on the schedule to perform the scan, says Hammer. 

Consider including this information in the file:

• Jane Doe
• Date of Birth:
• Practice ID #:
• Telephone #:

Date of last BMM screen:

Prior to performing the scan, verify with the patient whether she has had another scan by a different provider since the last known date of the DXA performed by your group. In some cases, you may not know when the patient last had a DXA scan. A call to the payer may help clear the question. But if you cannot locate the date of the previous scan, your office should ask the patient to sign an advance beneficiary notice (ABN). That way, the patient will be responsible for payment if Medicare denies the claim.

Exception: Medicare may pay for BMMs more frequently than every two years if documentation shows medical necessity. Medicare gives the following examples:

Monitoring beneficiaries on long-term glucocorticoid (steroid) therapy of more than 3 months Confirming baseline BMMs to permit monitoring of beneficiaries in the future.

3. Count 5 Coverage Categories

Five types of beneficiaries who may qualify for covered BMM services are listed in MBPM, Chapter 15, Section 80.5.6:

Osteoporosis risk: A woman's treating physician or NPP may use medical history and other findings to decide the patient is estrogen-deficient and at risk for osteoporosis. In that case, she may be BMM-eligible. Even women on estrogen replacement therapy may qualify. The treating practitioner should be sure to document in the medical record why he or she believes that the woman is estrogen-deficient and at clinical risk for osteoporosis, according to the MBPM.

Vertebral abnormality: A patient with X-ray results that indicate osteoporosis, osteopenia, or vertebral fracture may have a covered BMM.

Hyperparathyroidism: BMM coverage applies to beneficiaries with primary hyperparathyroidism.

Steroid therapy: Patients receiving (or expecting to receive) glucocorticoid therapy are eligible for BMM coverage. To qualify, the patient's dosage must be equivalent to an average of 5.0 mg of prednisone, or greater, per day, for more than 3 months.

Monitoring: Medicare covers BMM to monitor a patient's response to FDA-approved osteoporosis therapy.

4. Look Beyond National Policy for ICD-9

For accurate bone scan claims, coders need to become experts on the national coverage determinations (NCDs), local coverage determinations (LCDs), procedure codes, and diagnosis codes affecting their practice, advises Michaeleen OSullivan, BS, CCS, CCS-P, CMT, media director for FreeCodingCEUs.com and owner of Central Business School in Michigan.

NCD: Medicare's National Coverage Determination (NCD) for BMM instructs you to see MBPM, Chapter 15, Section 80.5, for coverage conditions and Medicare Claims Processing Manual (MCPM), Chapter 13, Section 140, for claims processing instructions (.