Pediatric Coding Alert

Question: A 14-year-old established patient presented for a follow-up visit after an episode of respiratory distress with wheezing where she needed a nebulizer or inhaler treatment. The pediatrician evaluated the child’s respiratory status, including spirometry and discussing further management. Which code(s) should we report?

Answer: In this case, you should report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) along with an E/M code for the office visit, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity ...). Because 99214 is bundled into 94010 according to the Correct Coding Initiative (CCI) edits, you will need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99214 to collect for both services.

Sometimes a single treatment or test is enough, but if the pediatrician wants more information, she may administer a simple spirometry test, treat the patient with an inhaled bronchodilator, and conduct a follow-up spirometry test. This pre/post test approach is useful in establishing an asthma diagnosis. For that type of test, you’ll report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with modifier 25 appended to the appropriate E/M code.