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Vertebral fracture assessment (VFA) with densitometry is a technique to assess vertebral fractures at the same time as bone mineral density (BMD), by use of dual-energy x-ray absorptiometry (DXA). The addition of vertebral fracture assessment to BMD may provide information on an individual’s risk of fracture.
Vertebral fractures are highly prevalent in the elderly population, and epidemiologic studies have found that these fractures are associated with an increased risk of future spine or hip fractures independent of bone mineral density. Only 20%–30% of vertebral fractures are recognized clinically; the rest are discovered incidentally on lateral spine radiographs. Lateral spine radiographs have not been recommended as a component of risk assessment for osteoporosis because of the cost, radiation exposure, and the fact that the radiograph would require a separate procedure in addition to the bone mineral density study using DXA. However, several densitometers with specialized software are able to perform VFA in conjunction with DXA. The lateral spine scan is performed by using a rotating arm; depending on the densitometer used, the patient can either stay in the supine position after the bone density study or is required to move onto the left decubitus position.
Vertebral fracture assessment (VFA) differs from radiological detection of fractures, as VFA uses a lower radiation exposure and can detect only fractures, while traditional radiograph images can detect other bone and soft tissue abnormalities in addition to spinal fractures. Manufacturers have also referred to this procedure as instant vertebral assessment, radiographic vertebral assessment, dual-energy vertebral assessment, or lateral vertebral assessment.
For both lateral spine radiographs and images with densitometry, vertebral fractures are assessed visually. While a number of grading systems have been proposed, the Genant semiquantitative method is commonly used. This system grades deformities from I to III, with grade I (mild) representing a 20%–24% reduction in vertebral height, grade II (moderate) representing a 25% to 39% reduction in height, and grade III (severe) representing a 40% or greater reduction in height. The location of the deformity within the vertebrae may also be noted. For example, if only the mid-height of the vertebrae is affected, the deformity is defined as an endplate deformity; if both the anterior and mid-heights are deformed, it is a wedge deformity; and if the entire vertebrae is deformed, it is classed as a crush deformity. A vertebral deformity of at least 20% loss in height is typically considered a fracture. Accurate interpretation of both lateral spine radiographs and VFA imaging is dependent on radiological training. Thus, device location and availability of appropriately trained personnel may influence diagnostic accuracy.
To perform vertebral fracture assessment with a densitometer, additional software is needed, and it must have 510(k) marketing clearance from the FDA. Products that have received FDA clearance include Lunar Dual Energy Vertebral Assessment (DVATM; General Electric Medical Systems) and Instant Vertebral AssessmentTM (IVATM; Hologic) software.
See separate medical policy for Bone Mineral Density Studies.
Screening for vertebral fractures using dual-energy x-ray absorptiometry (DEXA or DXA) is considered investigational.
Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
3/31/2005: Approved by Medical Policy Advisory Committee (MPAC)
6/6/2005: Code Reference section completed
3/16/2006: Policy reviewed, no changes
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
5/15/2007: Policy reviewed, description updated. Morphometric absorptiometry changed to dual x-ray absorptiometry in policy statement. Policy name changed to "Vertebral Fracture Assessment with Densitometry." Previously named "Screening for Vertebral Fracture with Dual X-ray Absorptiometry (DEXA)."
04/19/2011: Policy description and statement unchanged. Added FEP verbiage to the Policy Exceptions section. Removed deleted CPT code 76077 from the Code Reference section.
03/02/2012: Policy reviewed; no changes.
04/03/2013: Policy reviewed; no changes.
03/21/2014: Policy reviewed; no changes.
06/17/2014: Policy reviewed; description updated. Policy statement unchanged.
12/31/2014: Added the following new 2015 CPT code to the Code Reference section: 77086.
07/23/2015: Code Reference section updated for ICD-10.
09/25/2015: Policy reviewed; policy statement unchanged. Investigative definition updated in the Policy Guidelines section.
05/31/2016: Policy number A.6.01.44 added. Removed deleted CPT code 77082 from the Code Reference section.
10/13/2016: Policy description updated. Policy statement updated to change "dual x-ray" to "dual-energy x-ray."
Blue Cross Blue Shield Association Policy # 6.01.44
This may not be a comprehensive list of procedure codes applicable to this policy.
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