2025 ICD-10-CM code Z13.820
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons encountering health services for examinations Chapter 21: Factors influencing health status and contact with health services Feed
Encounter for screening for osteoporosis; this code is used when a patient is undergoing a screening for osteoporosis, not for diagnosing the condition itself.
Modifiers may be applicable depending on the specific circumstances of the visit and services performed.Consult your payer's guidelines for modifier usage.
Medical necessity for osteoporosis screening is often determined by patient risk factors, including age, gender, family history, medical conditions (such as rheumatoid arthritis or hyperparathyroidism), prior fractures, use of medications that affect bone density, and lifestyle factors such as smoking and low calcium intake.Specific guidelines may vary among payers.
The clinical responsibility for an encounter coded with Z13.820 involves performing a bone mineral density (BMD) test, typically a DEXA scan, and providing interpretation of the results to the patient. Physician may explain the significance of the findings, discuss risk factors, and recommend appropriate lifestyle modifications or further diagnostic/therapeutic interventions.
- Chapter 21: Factors influencing health status and contact with health services
- Z13.820 falls under the broader category of Z13.8 (Encounter for screening for other specified diseases and disorders), which is further classified under Z13 (Encounter for screening for diseases and disorders).It is part of Chapter 21 of the ICD-10-CM.
In simple words: This code means the doctor's visit was for a test to check for osteoporosis, a condition where bones become weak and break easily. The code is used for the visit itself, not for saying someone has osteoporosis.
This ICD-10-CM code, Z13.820, signifies an encounter for screening for osteoporosis.It's specifically used to code a visit where the primary reason is to conduct a bone density test or other screening procedure to assess the risk of osteoporosis.This code should not be used as a diagnosis code if the patient has already been diagnosed with osteoporosis; rather, it's utilized to reflect the purpose of the encounter. A separate diagnosis code should be used if there's an existing osteoporosis diagnosis or other related condition, such as postmenopausal state, vertebral fracture, hyperparathyroidism, or steroid therapy. This code is appropriate for various screening methods, including DEXA scans, QCT, BCT, and REMS.
Example 1: A 65-year-old postmenopausal woman presents for a routine osteoporosis screening. A DEXA scan is performed, and the results are reviewed with the patient, who is then counseled on lifestyle modifications to reduce her osteoporosis risk., A 50-year-old patient with a family history of osteoporosis requests an osteoporosis screening.A BMD test is conducted, and the patient receives counseling on risk factors and preventative measures. , A 72-year-old patient with a history of vertebral fracture undergoes a follow-up bone density scan after treatment for osteoporosis. Z13.820 is used to document the screening visit, and M81.0 (age-related osteoporosis without current pathological fracture) is added to the medical record.
Documentation should include the reason for the screening (e.g., age, family history, risk factors).The specific type of bone density test performed should also be recorded, along with the test results, the T-score, and any other relevant clinical findings.Patient education and counseling provided should be documented.
** This code should only be used for screening visits, not for managing established osteoporosis.Always ensure the documentation supports the medical necessity for the screening.This code is used in conjunction with procedure codes (CPT or HCPCS) that reflect the type of screening test (e.g., DEXA scan).
- Revenue Code: Revenue codes will vary depending on the payer and the specific services provided during the encounter.Consult your payer's guidelines for appropriate revenue codes.
- RVU: RVUs are not directly assigned to ICD-10 codes. The reimbursement for the encounter will be determined by the procedures performed during the visit (e.g., bone density scan), which will have associated CPT or HCPCS codes with RVU values.
- Global Days: Not applicable to this ICD-10 code, as it represents an encounter for screening and not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable to Z13.820.This code is only for the visit itself and doesn't represent a procedure with a technical and professional component.
- Fee Schedule: Fee schedules are dependent on the payer and the specific services provided.There is no set fee schedule for this ICD-10 code.
- Specialties:Endocrinology, Rheumatology, Internal Medicine, Geriatrics, and other specialties that may screen for or treat osteoporosis.
- Place of Service:Office, Outpatient Hospital, Other Outpatient Setting