Watch Out: LMRPs Restrict Repeat Spirometries Payment

Make sure you dot your I's and cross your T's when it comes to billing for repeat spirometries in the office, because most local medical review policies (LMRPs) strictly regulate when you can charge out multiple spirometric readings.

Spirometry (94010) is a basic ventilation test within the battery of assessments that constitute pulmonary function testing (PFT), says Cynthia Thompson, CPC, senior consultant at a physician practice management and consulting firm in Atlanta. An allergist would most often use spirometry for preoperative testing, to evaluate lung disease, to appraise the effects of systematic diseases on lung function, or to assess the effectiveness of treatment, she says.
National Guidelines Do Not Restrict
Medicare has not established frequency rates for billing spirometry. And there is no global period, which means you can bill the procedure more than once on a given day, if there is medical necessity. For example, an allergist sees a patient who presents with a muscular abnormality or other condition that requires multiple spirometries. The physician performs spirometry in the supine and upright positions.
In this case, you should code the comorbid conditions and include this information in the allergist's report. Append modifier -76 (Repeat procedure by same physician) to the subsequent spirometry to indicate that the physician repeated the procedure after the initial service.
LMRPs Limit Repeat Spirometries
Be aware, however, that local carriers may place restrictions on repeat spirometries.

For example, Palmetto GBA, a South Carolina local carrier, states, "Indications for repeat testing include preoperative evaluation in patients with known lung disease or for tracking pulmonary expressions of diseases." Palmetto GBA will also pay for repeat spirometry if the allergist uses it to quantify responses to therapy, make early diagnoses of lung injury after occupational exposures and drug or radiation therapy, or evaluate response to bronchodilator therapy or steroids.
The local carrier will not pay repeat spirometries when performed for patients on bronchodilator. "Repeat spirometry (94010, 94060, 94150-94375) performed for patients on bronchodilator therapy presenting without new symptomatology is considered routine screening [and] is not covered," Palmetto's LMRPstates. For patients with chronic cough, their initial workup includes PFTs, so allergists will not perform repeat procedures without additional symptomology or failure to respond to a prescribed treatment.

According to another local carrier, Cahaba GBA, repeat testing requires documented medical justification. That documentation should demonstrate things like unexpected changes in symptoms of respiratory disease, evaluation of ongoing therapy to determine changes, and monitoring signs of lung transplant rejection.

It may be appropriate to report repeat testing if it determines whether a nebulizer treatment has been effective or if the patient needs another treatment on the same day, says Teresa Thompson, CPC, [...]

- Published on 2003-03-01