CT Colonography for Osteoporosis Assessment

A new study by a group of American researchers reveals computed tomographic (CT) colonography used for screening colorectal cancer can also provide information about patient bone health and osteoporosis. CT colonography or virtual colonoscopy is a diagnostic test that produces high resolution two and three-dimensional images of the colon and rectum with the use of CT scanning and computer generated images. Radiologists can detect suspicious lesions by analyzing these high resolution images. Appropriate radiology medical coding is important when reporting CT colonography screening. If a suspicious condition is found, that patient should undergo further testing via a conventional colonoscopy.

In this study, the researchers evaluated the efficacy of retrospective analysis of CT colonography in a comprehensive osteoporosis assessment. Each of 136 women (age range, 43–92 years) participants underwent CT colonography and dual-energy x-ray absorptiometry (DXA) within a six-month period. The diagnosis of osteoporosis and the assessment of fracture risk were compared between the results obtained from biomechanical CT analysis and results obtained from DXA. Several techniques were used to compare the results such as Regression, Bland-Altman, and reclassification analyses and paired t tests.

In the case of bone mineral density T scores at the femoral neck, biomechanical CT analysis was highly correlated with DXA and did not differ from DXA. It was possible to detect osteoporosis (as defined by DXA) in eight of eight patients with 100 percent sensitivity and in 126 of 128 patients with 98.4 percent specificity. For the hip and spine, the classification of patients at high risk for fracture as defined by biomechanical CT analysis matched up with the classifications for clinical osteoporosis defined by DXA with 82.8% sensitivity in 24 of 29 patients and 85.7% specificity in 66 of 77 patients. It was concluded in the study that retrospective biomechanical CT analysis of CT colonography for colorectal cancer screening provides a comprehensive osteoporosis assessment and that without making any changes in imaging protocols.

Coding for CT Colonography

Though CT Colonography is a very effective screening method, it is quite difficult to gain full reimbursement for this particular procedure. This is because most insurance companies do not reimburse CT Colonography currently while certain companies reimburse only if it is done for diagnosis, especially after an incomplete optical colonoscopy. Some companies require medical necessity as well. In most cases, the patients calling for screening CT Colonography will require to assume the cost of screening themselves. Radiologists should prepare their documentation appropriately and report the procedure and diagnosis using the correct codes. The CPT codes for this procedure are:

• 74261: Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material
• 74262: Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed
• 74263: Computed tomographic (CT) colonography, screening, including image postprocessing

Diagnostic Coding for Osteoporosis

The ICD-9 codes are as follows.

• 733.0: Osteoporosis
• 733.00: Osteoporosis, unspecified
• 733.01: Senile osteoporosis
• 733.02: Idiopathic osteoporosis
• 733.03: Disuse osteoporosis
• 733.09: Other osteoporosis

The upcoming ICD-10 medical coding system basically denotes osteoporosis, with and without pathological fracture.

• M80: Osteoporosis with current pathological fracture
• M81: Osteoporosis without current pathological fracture

If the condition is osteoporosis with current pathological fracture, ICD-10 further specifies the exact location of the fracture, laterality, episode of care and fracture healing. Examples are:

• M80.01: Age-related osteoporosis with current pathological fracture, shoulder
• M80.011: Age-related osteoporosis with current pathological fracture, right shoulder
• M80.011A: Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
• M80.011D: Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
• M80.011G: Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
• M80.011K: Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
• M80.011P: Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
• M80.011S: Age-related osteoporosis with current pathological fracture, right shoulder, sequela

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