Oncology & Hematology Coding Alert

Question: Medicare has denied our claims for pulmonary function tests that are part of the prechemotherapy workup. What can we do to get paid?

Pennsylvania Subscriber Answer: Make sure you are not billing for PFTs (94010-94799) that Medicare has bundled when the physician performs them on the same date. For instance, you cannot report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) in addition to 94150 (Vital capacity, total [separate procedure]). That's because code 94010 includes vital capacity, and therefore, Medicare considers 94150 a part of spirometry.

The final step: Make sure you are listing the correct  ICD-9 malignancy code that justifies your oncologist using a PFT. For example, Blue Cross Blue Shield of Georgia will pay for spirometry when the physician is treating a malignant neoplasm of trachea, bronchus or lung (162.x).