Pediatric Coding Alert

Question: When billing for two spirometries during the same visit, a pre- and post-spirometry, should I bill 94010 for the first spirometry and 94060 for the second reading? Or should I use 94060-25 x 2 units for both readings?

Kentucky Subscriber

Answer: Check whether the encounter involved bronchodilation. Code 94060's (Bronchodilation responsiveness, spirometry as in 94010, pre-and post-bronchodilator administration) values include three items: pre-bronchodilation measurement, bronchodilation, and post-bronchodilation measurement. Code 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) includes all readings without bronchodilator administration. Here's how to code each scenario:

• If, to test a bronchodilator's effectiveness, the pediatrician interpreted a graphic reading before and after office staff administered a bronchodilator, 94060 is the correct code without a modifier and with 1 unit.

• If, however, the physician interpreted two graphic readings that a nurse or medical technician took without administering a bronchodilator, you would report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) without a modifier and with 1 unit. Code 94010 specifies "measurement(s)", singular and plural.

You should use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) only on an E/M service code (such as office visits 99201-99215), not on a procedure code, such as diagnostic test code 94060.