Primary Care Coding Alert

Question: Can I report a pulmonary function test (PFT) CPT^® code twice if my provider repeats the procedure on the same day?

Wisconsin Subscriber

Answer: Yes … and no. Let’s look a little closer at a couple of scenarios to find out.

Let’s say the provider performs a PFT such as spirometry on a patient, but the values are inconclusive, or the physician needs additional testing to make a definitive diagnosis. The provider then requests repeat testing on the same day. In that case you’d code 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) twice and append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the second instance. Use of the modifier requires sufficient documentation though. You need to be able to show the need for the repeat test as well as the same-day test.

Note: Do not report 94010 twice if the initial testing was incomplete due to equipment failure or the patient’s inability to follow the instruction.

On the other hand, you’d report a single, unmodified code if the provider performed multiple spirometry tests with specific stimulants to evaluate the patient for bronchospasm in response to the agents. For this scenario, you’d assign 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)) without modifier 76. Code 94070’s descriptor includes “multiple spirometric determinations,” which means that the provider can perform the test as many times as necessary to evaluate the patient’s condition.

Likewise, if the provider performed 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration), you would only report the code once and without a modifier, because the repetition of the spirometry (before and after bronchodilator administration) is already captured in the code descriptor.

In short, you may report a PFT code twice using modifier 76 if the provider repeats the procedure on the same day as long as the code describing the PFT does not already encompass multiple instances of the PFT.