Primary Care Coding Alert

Beware of bundling bungles.

Now that respiratory illness season is in full swing, your provider is probably administering more spirometry tests than usual. So, here’s a timely reminder that spirometry coding isn’t always as easy as breathing.

One reason for that is the way some spirometry services are bundled, either by CPT^® guidelines or National Correct Coding Institute (NCCI) procedure-to-procedure (PTP) edits. But if you review the following two scenarios, you’ll be able to keep everything straight when you code this important service.

The Wrong, and the Right, Way to Code Spirometry

Scenario 1: Your provider suspects a patient has a lung condition and decides to conduct a spirometry test on the patient. The test measures the maximal amount of air the patient is able to forcibly breathe out during a short period of time (the total and timed vital capacity of the patient’s lungs) and expiratory flow rate, or EFR (the maximum speed with which the patient can empty his or her lungs). The results are recorded on a graph and interpreted by the provider.

You might be tempted to code each part of this test separately, using 94150 (Vital capacity, total (separate procedure)) for the vital capacity test, 94200 (Maximum breathing capacity, maximal voluntary ventilation) for the EFR, and 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) for the report and interpretation.

But doing so would be incorrect. That’s because CPT^® guidelines “do not allow you to report 94150 and 94200 in conjunction 94010,” notes JoAnne M. Wolf, RHIT, CPC, CEMC, AAPC Fellow, coding manager at Children’s Health Network in Minneapolis.

This is reflected in the NCCI PTP edits for the codes. However, “codes 94150 and 94200 do have a 1 listed in the modifier indicator column, indicating that use of modifier 59 [Distinct Procedural Service] would be appropriate, but only if your provider performed the lung capacity/volume measurement in a separate encounter. If performed together, then the billing and use of the modifier would not be appropriate,” Wolf clarifies.

But you really don’t need to check CPT^® or NCCI guidelines to know that reporting 94150 and 94200 with 94010 is prohibited. A close reading of the descriptor for 94010 notes that it includes “total and timed vital capacity,” and that it can be used “with or without maximal voluntary ventilation.” So, for our first scenario, it would only be necessary for you to report 94010 to accurately describe the encounter.

Coding Alert 1: Code 94010 can be used for patients over 2 years of age. Spirometry for infants and children through to the age of 2 should be coded with 94011 (Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age).

The Wrong, and the Right, Way to Code Bronchodilator Responsiveness

Scenario 2: Your provider administers a 94010 spirometry test on the patient. Then, your provider decides to see if the patient’s condition can be improved by administering albuterol, a common bronchodilator drug that helps to relax the lung muscles and dilate the bronchi, the lung’s airways, for 45 minutes, making it easier for the patient to breathe. Your provider then administers a second 94010 test to see if the bronchodilator has improved the patient’s lung volume and respiration.

In this scenario, you might also think that coding each component of this scenario is the way to go. But coding two units of 94010, along with modifier 51 (Multiple Procedures) or modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) and separately coding the bronchodilator treatment with 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device) would also be incorrect.

As with Scenario 1, CPT^® guidelines prohibit you from coding the services this way. Specifically, CPT^® guidelines state, “When spirometry is performed before and after administration of a bronchodilator, report 94060.” Thus, as with 94010, there is a combination code that reports all parts of this service: 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration).

Per its descriptor, you can see that 94060 includes all the component parts of 94010 and the therapeutic or diagnostic aspect of 94640. NCCI edits do allow you to use a modifier to override the edit pair when 94640 is the column 2 code with 94010. However, in this scenario, there is a single code, 94060, that captures the entire service, and reporting 94010 and 94640 in lieu of 94060 would represent an inappropriate unbundling of the service.

Coding Alert 2: Like 94010, 94060 is intended for patient older than 2 years of age. For patients 2 years of age or younger, you should report 94012 (Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age).