Pediatric Coding Alert

When a pediatrician needs to ascertain how well a childs lungs are functioning, a peak flow meter is often used. For example, this low-cost device can indicate whether an asthmatic is having more breathing problems than he or she should and needs medication. However, coding for this procedure is not always clearsome practices dont even bill for it.

Two practicesa primary care practice, and an allergy and pulmonary subspecialty practiceadvocate different approaches to coding for peak flow meters. Obviously, the pediatric allergy and pulmonary practice does many more of these, so we have focused on their method in this article.

1. Use 94150. This is the code for total vital capacity measurements, and should be used for peak flow readings, says Carol Tyrrell, office manager for Allergy and Pediatric Pulmonary Associates, a three-pediatrician practice in Akron, OH.

Tip: A primary care pediatric office might not use this code for just a peak flow. A total vital capacity measurement is more complex than a peak flow, utilizing equipment with chart paper. You might be able to upcode your office visit, however, depending on the remaining elements involved.

2. Use the office-visit code too. If another procedure is performed during the office visit, Tyrrell uses the appropriate office-visit code as well as 94150. Some insurance companies wont pay for the 94150, however, and pay for the office visit instead. They think the peak flow should be incorporated into the office visit, says Tyrrell.

Note: CPT states that you should report an additional E/M services code as well as 94150 providing that a separate identifiable Evaluation and Management service is performed. This means that if you dont do anything in the office visit but evaluate the childs wheezing, that is clearly connected to the peak flow and cannot be reported separately. However, if you also treat a childs otitis media, that is not connected and warrants a separate office-visit code.

3. If spirometry is done, there is no code for peak flow. If the peak flow reading is low, Tyrrells practice then does a spirometry (94200). We dont charge for the peak flow if we do a spirometry, Tyrrell reports.

4. The diagnosis codes. Usually, the diagnosis code used when doing peak flow readings is asthma (493.0 or 493.9). In addition, a diagnosis code for wheezing (786.09) can also be used. I think that if the patient is wheezing and having trouble breathing, insurance should certainly pay for the peak flow, says Tyrrell.

5. Low value. It should be noted that were not talking about a lot of money in the 94150 code. HealthCare Consultants of Americas Physicians Fee and Coding Guide for 1998 gives it a range of $15-$25. Medicare wont even pay for it. This is why, if the health plan denies the claim, you may want to think twice before you appeal it. On the other hand, if you do quite a few peak flow readings, you may want to pursue appeals.

6. The laissez-faire view. We dont bill for hand-held peak flow readings, says Frances Eichenfield, office manager for Rockville Centre Pediatrics, a three-pediatrician practice in Rockville Centre, NY. The pediatricians do it themselves, she reports, and we bill for an office visit. Laughing, Eichenfield notes that theres quite a bit that doesnt get itemized during these visits. Bill for peak-flow meters? We havent even given it a thought, she says.