Pediatric Coding Alert

Question: We are looking into buying a digital spirometer. What is the difference between 94010 and 94060? Are these codes paid?

New Jersey Subscriber

Answer: Although both codes involve spirometry, only the latter code also involves bronchodilator administration. When a nurse takes a spirometric reading alone to measure a patient's exhalation volume and speed, report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). When the nurse performs spirometry, bronchodilator administration and another spirometry, you should report all three services with the combination code 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration).

The 94060 test helps assess if a patient with difficulty breathing, wheezing or asthma will respond to bronchodilation treatment. The initial spirometry provides a base-line measurement to compare to another spirogram taken after the patient receives bronchodilator administration.

Be careful: When reporting 94060, do not separately bill the spirometry before and after bronchodilator administration. Code 94060 includes the relative value units (RVUs) for 94010.

The Medicare Physician Fee Schedule assigns 0.91 RVUs to 94010, and 1.57 RVUs to 94060. Nationally, the single determination code pays about $35 (0.91 RVUs x 38.0870 conversion factor), and bronchodilation responsiveness unadjusted pays about $60 (1.57 RVUs x 38.0870).