Pediatric Coding Alert

Question: My practice is interested in doing pulmonary function testing on asthma patients. How should we bill? CPT 94010 ? 94016? Can we charge a copayment? Is it worth buying a spirometry device?

Ohio Subscriber

 
Answer: Pulmonary function testing should be billed with 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). Thank you for mentioning spirometry: Too many physicians think they can bill 94010 for a hand held peak-flow meter, which has no code and is not separately billable.
 
Do not code 94016 (patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only) unless the patient had a spirometer at home. The key to coding 94016 is performing the interpretation, whether you receive reports over the phone lines from a rented machine in the patients home, or the patient brings printouts in.
 
The other code for pulmonary function testing is 94060 (bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). Do not use 94060 and 94010 on the same day. The bronchodilation is included in the 94060; do not bill for it separately.
 
Both 94060 and 94010 require a spirometer with a mechanism that displays results graphically. Whether it is worth purchasing one depends on the number of asthma patients you have. Many pediatricians treat asthma without a spirometer; but, pediatricians who specialize in asthma and allergy could not get by without one. Primary care pediatricians should know that its not always easy to get good spirometry on younger children.