Otolaryngology Coding Alert

Question: My allergist performs pre- and post-treatment pulmonary function tests (PFTs). How should we report these?

California Subscriber Answer: If your allergist performs a bronchospasm evaluation to determine the patient's responsiveness to treatment, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration). This code includes the spirometry measurements both pre- and post-bronchodilator administration.

Carriers do not consider the bronchodilator cost as part of the payment for 94060. Consequently, CPT suggests that you report 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies or materials provided]) or the appropriate drug code.
If you report a drug code instead, you should choose a HCPCS code that identifies the specific drug and the amount the physician administered during the evaluation.

For example, if the physician uses Albuterol, you may select the most appropriate code (such as, J7613, Albuterol, inhalation solution, administered through DME, unit dose, 1 mg), depending on the specific form and dose the physician administers.

But if the patient has an acute exacerbation of asthma (493.02, Extrinsic asthma; with [acute] exacerbation) and the physician must administer an inhaled bronchodilator, you should report 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) in addition to the appropriate J code representing the drug.

If the physician demonstrates and/or evaluates the patient administration of the drug, you should consider the demonstration/evaluation a component of 94640. You should not report the demonstration/evaluation separately