CPT® Code 77090

Official Description

Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere

Common Language Description

The Trabecular Bone Score (TBS) is a diagnostic tool used to assess the structural condition of bone microarchitecture, particularly in the context of osteoporosis evaluation and fracture risk prediction. This score is derived from a previously obtained dual X-ray absorptiometry (DXA) image, which is a standard method for measuring bone mineral density. The TBS provides an indirect measurement of bone strength and microarchitecture without the need for invasive procedures. It operates by analyzing pixel gray-level variations within the DXA image of the lower spine, where different types of bone structures exhibit distinct patterns of x-ray absorption. A dense trabecular bone structure will display numerous pixel-to-pixel gray-scale variations with minimal amplitude, indicating a robust bone architecture, while a porous structure will show fewer variations with greater amplitude, suggesting a weaker bone composition. The TBS is calculated through a variogram, which quantifies the differences in gray levels between adjacent pixels, ultimately yielding a score that reflects the trabecular density. A higher TBS indicates a stronger, more fracture-resistant bone microarchitecture, whereas a lower score suggests a higher susceptibility to fractures. The technical preparation and transmission of data for TBS analysis are captured under CPT® Code 77090, which specifically refers to the work involved in preparing and sending the data for further analysis at a different location.

1. Indications

The Trabecular Bone Score (TBS) is indicated for use in the evaluation of osteoporosis and the assessment of an individual's fracture risk. It is often performed in conjunction with a bone mineral density exam to provide a comprehensive understanding of bone health.

Osteoporosis Evaluation The TBS is utilized to assess the structural integrity of bone microarchitecture in patients suspected of having osteoporosis.
Fracture Risk Prediction The score aids in predicting the likelihood of fractures in individuals, particularly those with risk factors for osteoporosis.

2. Procedure

The procedure for obtaining a Trabecular Bone Score involves several key steps that ensure accurate data collection and analysis. Initially, a dual X-ray absorptiometry (DXA) scan is performed on the lower spine to capture the necessary imaging data. This scan utilizes both high and low energy x-ray photons to differentiate between various body tissues based on their absorption characteristics. Once the DXA image is acquired, the technical preparation for TBS begins. This includes the processing of the DXA image to evaluate pixel gray-level variations, which are critical for calculating the TBS. The variogram is then computed, which involves summing the squared differences in gray levels between adjacent pixels. This mathematical approach characterizes the rate of gray-level amplitude variations, leading to the final TBS calculation. The resulting score reflects the trabecular density and the strength of the bone microarchitecture. It is important to note that the technical preparation and transmission of this data for analysis at another location is specifically reported under CPT® Code 77090.

Step 1: DXA Scan A dual X-ray absorptiometry scan is performed to obtain an image of the lower spine, which serves as the basis for TBS analysis.
Step 2: Image Processing The acquired DXA image undergoes technical preparation, focusing on evaluating pixel gray-level variations essential for TBS calculation.
Step 3: Variogram Calculation A variogram is calculated by summing the squared gray-level differences between pixels, which is crucial for determining the TBS.
Step 4: TBS Calculation The TBS is calculated based on the variogram, providing an indirect measurement of trabecular bone density and microarchitecture strength.

3. Post-Procedure

After the TBS procedure, the data is transmitted to another location for further analysis. The results of the TBS calculation will be interpreted, and a report detailing the patient's fracture risk will be generated. This report is essential for guiding clinical decisions regarding osteoporosis management and potential interventions. It is important for healthcare providers to review the TBS results in conjunction with other clinical findings and assessments to develop a comprehensive treatment plan for the patient.

Short Descr	TBS TECHL PREP&TRANSMIS DATA
Medium Descr	TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR
Long Descr	Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component 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	01 - Procedure must be performed under the general supervision of a physician.
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	Procedure or Service, Not Discounted when Multiple
Berenson-Eggers TOS (BETOS)	none
MUE	1

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.