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The Trabecular Bone Score (TBS) is a diagnostic tool utilized to assess the structural condition of bone microarchitecture, particularly in the context of osteoporosis evaluation and fracture risk prediction. This score is derived from dual X-ray absorptiometry (DXA) imaging or other imaging modalities that analyze gray-scale variograms. The TBS provides an indirect measurement of bone strength and microarchitecture without the need for invasive procedures. It evaluates the variations in pixel gray levels from a previously obtained DXA image of the lower spine, which is crucial for understanding the trabecular bone structure. The underlying principle of DXA imaging is that different types of body tissues absorb X-ray photons differently, allowing for a detailed analysis of bone density and structure. A dense trabecular bone structure is characterized by numerous pixel-to-pixel gray-scale variations with small amplitude, indicating a robust bone microarchitecture. Conversely, a porous bone structure exhibits fewer variations with higher amplitude, suggesting a weaker bone composition. The TBS is calculated by analyzing the variogram, which quantifies the sum of squared gray-level differences between pixels, ultimately providing a score that reflects the trabecular density. A higher TBS indicates a stronger, more fracture-resistant bone microarchitecture, while a lower score suggests a higher susceptibility to fractures. The final TBS score is interpreted, and a comprehensive report detailing the patient's fracture risk is generated, aiding healthcare professionals in making informed decisions regarding patient care and management.
© Copyright 2025 Coding Ahead. All rights reserved.
The Trabecular Bone Score (TBS) is indicated for the evaluation of osteoporosis and the assessment of fracture risk in patients. It is particularly useful in the following scenarios:
The procedure for obtaining a Trabecular Bone Score involves several key steps that ensure accurate measurement and interpretation:
After the TBS procedure, patients may not require any specific post-procedure care, as the process is non-invasive and typically does not involve any recovery time. However, it is important for healthcare providers to review the TBS report with the patient, discussing the implications of the score and any necessary follow-up actions. Patients may be advised on lifestyle modifications, further diagnostic testing, or treatment options based on their fracture risk assessment. Continuous monitoring and reassessment may be recommended, especially for individuals with low TBS scores, to ensure appropriate management of their bone health.
| Short Descr | TBS DXA CAL W/I&R FX RISK | Medium Descr | TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK | Long Descr | Trabecular bone score (TBS), structural condition of the bone microarchitecture; using dual X-ray absorptiometry (DXA) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 4 - Global Test Only Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | GA | Waiver of liability statement issued as required by payer policy, individual case | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | CR | Catastrophe/disaster related | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q3 | Live kidney donor surgery and related services | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2022-01-01 | Added | Code added |
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