Stumped by Methacholine Challenge Tests? Follow 6 Steps to Proper Coding

If your allergist recommends that a patient with breathing problems take a methacholine challenge test, you'll need to know what that means and how to handle billing the procedure. Hint: It's not as "challenging" as you think.
 
Allergists who specialize in asthma treatment and pulmonologists use methacholine provocation challenge tests (94070) to determine if a patient has respiratory diseases such as bronchial asthma (493.9x). Physicians perform spirometries (94010) after each methacholine inhalation to measure the patient's airway responsiveness and to determine if the patient exhibits a bronchospastic response (519.1).
 
Coding experts offer these six tips for mastering methacholine testing:
1. Report Professional and Technical Components
Reporting methacholine challenge testing accurately means having a clear understanding of what the tests include and what part of the test the physician can report. 
 
Use 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) for the methacholine administration, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.
 
Code 95070 does not include payment for the pulmonary function tests (PFTs) required to evaluate the patient's prolonged postexposure bronchospasm, so you should report 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) for the postexposure bronchospasm evaluation in addition to 95070, Pohlig says.
 
Typically, physicians perform methacholine studies in a hospital's pulmonary function testing lab. When this occurs, each "entity" reports its portion of the service. In other words, the pulmonary function lab will report the methacholine administration (95070) in addition to the "technical" portion of the evaluation, which is performing the spirometric measurements (94070-TC), Pohlig says. The physician will report his or her "professional" portion, which includes interpreting the spirometric measurements (94070-26), she adds.
2. Check the Report for Appropriate FEV1 Drop
A crucial part of methacholine testing is measuring patients' levels of forced expiratory volume in one second (FEV1). So you should watch for these measurements in the report to support medical necessity for the tests, coding experts say.
 
For instance, an allergist may examine an established patient (99211-99215) for shortness of breath (786.05) and evaluate the patient's labored breathing. As part of the evaluation, he or she performs a spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) to measure the patient's respiratory function, which is near normal.
 
The patient's symptoms lead the allergist to suspect a possible asthmatic condition (493.00, 493.10, 493.20, 493.90), so he or she orders a methacholine challenge test in the PFT lab. The patient receives the methacholine in the lab, [...]

- Published on 2003-07-01