Pediatric Coding Alert

Question: I never know when to charge for peak flow separately or when the visit includes the service. What should I code and when?

California Subscriber

Answer: Commonly used with a diagnosis of asthma, the peak-flow monitor allows the pediatrician to better understand the state of the asthma in a patient (mild, acute, etc.). Often, pediatricians refer to this when a patient comes in with asthma and an upper-respiratory infection. They will ask the patient's parent what the child's peak-flow best is and take another reading with the patient in the office to judge the severity of the condition with the upper-respiratory complication/infection.
 
From a CPT perspective, when performed, peak-flow rate is an inherent part of the E/M examination, and you should not separately report the test. Don't report 94150 (Vital capacity, total [separate procedure]) for peak flow. Code 94150 describes computerized spirometry, not peak-flow measurement. When your pediatrician uses the handheld peak flow meter, you instead should include the diagnostic test in the E/M service. Count the measurement as part of "the amount and/or complexity of data to be reviewed" medical decision-making element.
 
On the other hand, you should separately report spirometry (such as 94150 or 94200, Maximum breathing capacity, maximal voluntary ventilation).