Answer: 99204-25 77080-GA Diagnosis 733.01
As of January 2010, Medicare no longer acknowledges consultation codes (99241–99245). Therefore, the patient would be considered a new patient.
Keep in mind that Medicare generally covers a bonemass measurement for a beneficiary once every two years, or if at least 23 months have passed since the month the last bone-mass measurement was performed. The physician or ancillary staff will need to have the patient sign an Advance Beneficiary Notice (ABN) to ensure reimbursement before she leaves the office.
Physicians are required to have a signed ABN in the medical record of each patient that has a reasonable and necessary service. The above scenario is deemed reasonable and necessary and should be coded with the CPT code appended by the modifier GA.
The GA modifier notifies the Centers for Medicare and Medicaid Services that there is a signed and dated ABN on file for that service and the physician can bill the patient if Medicare does not reimburse for the procedure. If the patient does not sign the ABN, then the correct CPT code should be appended with a GZ modifier, indicating that there is no ABN on file and the patient cannot be billed for the denied charges.
