Primary Care Coding Alert

Question: What is the proper way to bill an E/M visit when performing spirometry during that visit?

Maine Subscriber

Answer: CPT^® doesn’t include a code for hand-held peak flow readings, because the service is included in the associated E/M for the patient’s visit. The payer will bundle any provider work associated with a peak flow into the E/M.

If you perform complete spirometry with a graphic record, code 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). You can also report an E/M code for the office visit on the claim. Although there is no Correct Coding Initiative that otherwise bundles 94010 and an E/M code, you may still want to append modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to the E/M code to indicate that it was significant and separately identifiable from the spirometry.