Mountain State Medical Policy Bulletin
Section: Radiology
Number: X-56
Topic: Vertebral Fracture Assessment Using Dual X-ray Absorptiometry (DXA)
Effective Date: January 1, 2007
Issued Date: January 1, 2007
Date Last Reviewed: 11/2006

General Policy Guidelines

Indications and Limitations of Coverage

Vertebral fracture assessment using dual x-ray absorptiometry (DXA) is considered an experimental/investigational procedure for all indications, including screening for vertebral fractures. When reported, this procedure will be denied as experimental/investigational. A participating, preferred, or network provider can bill the member for a service denied as investigational.

Recent studies have focused on vertebral fracture assessment as part of an osteoporosis risk assessment program. However, published information has not established the clinical impact of vertebral fracture assessment on diagnosing vertebral fracture or risk of fracture, therapeutic treatment management, and long-term patient outcomes. Further research is necessary to establish standardized indications for performing this study, interpreting the results, and proving its clinical utility among various patient populations. 

Description

Vertebral fracture assessment using dual x-ray absorptiometry (DXA) is an imaging method for identifying vertebral fractures or deformities in patients at risk for osteoporosis or osteoporotic fractures. It is also called instant vertebral assessment (IVA), morphometric x-ray absorptiometry (MXA), or lateral vertebral assessment (LVA). The fracture assessment technology is an add-on feature to the dual x-ray absorptiometry (DXA) scanner or densitometer. Using this method, lateral images of the spine can be obtained by performing a 10 second, low-dose single energy scan without subjecting the patient to a separate x-ray procedure.

This procedure is typically performed during the same patient encounter for a DXA scan. It provides the physician with a rapid assessment of the presence or absence of vertebral deformity(ies) including, vertebral fractures. Through this new method, the provider can magnify particular areas of interest or view the entire spine at once.

For additional information on bone density studies, refer to Medical Policy Bulletin X-24.


NOTE:
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Procedure Codes

77082     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

National Blue Cross Blue Shield Association Medical Policy #6.01.44

Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice, Osteoporosis International, February 2006

Detection of vertebral fractures, Current Osteoporosis Reports, December 2005

Official Positions of the International Society for Clinical Densitometry, Update 2005

Assessment of vertebral fracture using densitometric morphometry, Journal of Clinical Densitometry, October 2005

Vertebral deformities identified by vertebral fracture assessment: associations with clinical characteristics and bone mineral density, Journal of Clinical Densitometry, October 2005

Position Statement: Technical Standardization for Dual-Energy X-ray Absorptiometry, The Writing Group for the International Society of Clinical Densitometry, Journal of Clinical Densitometry, Vol. 7, Issue 1, Spring, 2004

Instant Vertebral Assessment, A Noninvasive Dual X-ray Absorptiometry Technique to Avoid Misclassification and Clinical Management of Osteoporosis, Journal of Clinical Densitometry, Vol. 4, No.4, Winter 2001

Recognizing and reporting osteoporotic vertebral fractures, European Spine Journal (September 2003), Vol. 12 (Suppl. 2)

Clinical utility of dual-energy vertebral assessment (DVA), Osteoporosis International, Vol. 14, (2003)

Prevalence of Vertebral Compression Fracture Deformity by X-ray Absorptiometry of Lateral Thoracic and Lumbar Spines in a Population Referred for Bone Densitometry, Journal of Clinical Densitometry, Vol. 5, No. 3, Fall 2002

Vertebral Fractures in Osteoporosis: A New Method for Clinical Assessment, Journal of Clinical Densitometry, Vol. 3, 2000

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.