Pediatric Coding Alert

Question: An insurance company told me that the code I use for peak flow (CPT 94250 ) is incorrect. What code should I use?

Ohio Subscriber

Answer: CPT considers peak-flow rate an inherent part of the E/M service and does not provide a distinct code for the diagnostic test. A HCPCS level II code exists for this service (S8110, Peak expiratory flow rate [physician services]). But insurers may follow Medicare's lead and consider S8110 incidental to pulmonary function testing and E/M services, as Empire State Medicare Services does.
 
Better practice: When a pediatrician uses the handheld peak-flow meter, you should instead 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.
 
Coders sometimes make the mistake of reporting peak-flow rate with 94150 (Vital capacity, total [separate procedure]), but 94150 describes computerized spirometry, not peak-flow measurement.
 
You should also not code peak-flow rate with 94250 (Expired gas collection, quantitative, single procedure [separate procedure]). Pediatricians frequently perform this test as part of a pulmonary stress test (94620, Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry] and 94621, ... complex [including measurements of CO2 production, O2 uptake, and electrocardiographic recordings]), and thus it is incidental to 94620-94621.

 -- Answers to You Be the Coder and Reader Questions reviewed/provided by Victoria S. Jackson, practice management consultant with JCM Inc. in California; and Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio.