April 30, 2016

Bone Mass Measurement ICD-10 Covered Services Updated

On April 12, 2016 the Centers for Medicare and Medicaid Services (CMS) clarified the removal of code M85.8 from the list of covered ICD-10-CM conditions for bone mass measurement studies.  The code removed is M85.80 (Other specified disorders of bone density and structure, unspecified site).  CMS included the list of ICD-10-CM diagnosis codes within subcategory M85.8_that providers may report as covered indications in addition to the current list provided in CR 9252  and its accompanying CMS spreadsheet.  The M85.8_subcategory codes include:

M85.811 Other specified disorders of bone density and structure, right shoulder 
M85.812 Other specified disorders of bone density and structure, left shoulder 
M85.821 Other specified disorders of bone density and structure, right upper arm 
M85.822 Other specified disorders of bone density and structure, left upper arm 
M85.831 Other specified disorders of bone density and structure, right forearm 
M85.832 Other specified disorders of bone density and structure, left forearm 
M85.841 Other specified disorders of bone density and structure, right hand 
M85.842 Other specified disorders of bone density and structure, left hand 
M85.851 Other specified disorders of bone density and structure, right thigh 
M85.852 Other specified disorders of bone density and structure, left thigh 
M85.861 Other specified disorders of bone density and structure, right lower leg 
M85.862 Other specified disorders of bone density and structure, left lower leg 
M85.871 Other specified disorders of bone density and structure, right ankle and foot 
M85.872 Other specified disorders of bone density and structure, left ankle and foot 
M85.88 Other specified disorders of bone density and structure, other site 
M85.89 Other specified disorders of bone density and structure, multiple sites 

The added M85.8- subcategory ICD-10-CM codes do not include the unspecified laterality codes (eg, M85.819, M85.829, M85.839 etc.).  Physicians should document the specific site AND laterality (left, right, or bilateral) for the disorders of bone density and structure.

CMS initially established a list of covered conditions and the corresponding ICD-10-CM codes for bone mass measurement studies on January 4, 2016 in CR 9252. That list was revised on April 6, 2016, to remove M85.8 as noted above.  All other information regarding covered conditions for bone mass measurement from the January transmittal remains the same.   The effective date is retroactive to the October 1, 2015 ICD-10 implementation date.

For more information please see MLN Matters Article SE1525

Please contact Dominick Parris in the Department of Economics and Health Policy with your questions at djparris@acr.org