4 Tips Give Your PFT Coding a Tune-Up
Published on Wed Jan 21, 2004
Use expert strategies to ensure reimbursement Although you may have trouble remembering all the pulmonary function test (PFT, 94010-94799) bundles when the pulmonologist diagnoses emphysema (492.0-492.8), don't give up.
Our coding experts offer four tips to give your PFT coding skill an update - and to help your physician get the proper payment. 1. Report Signs and Symptoms A patient with emphysema, a form of chronic obstructive pulmonary disease (COPD, 496), often presents to the office with a variety of symptoms, including shortness of breath (786.05), wheezing (786.07), and breathlessness (786.09).
After the patient sees your pulmonologist for symptoms like wheezing and shortness of breath, your physician performs numerous in-office tests to properly diagnose the disease, including PFTs and chest x-rays (71010-71035), says Judy Richardson, RN, MSA, CCS-P, a senior consultant at Hill and Associates, a coding and compliance consulting firm in Wilmington, N.C.
You should report codes for the presenting symptoms until your physician diagnoses emphysema. Once your pulmonologist confirms emphysema, however, you can report the appropriate emphysema diagnosis code, such as 492.0, Richardson says. Also, you can list ICD-9 codes, such as 786.07 and 786.09, in addition to 492.0. 2. Know 94010 and 94060 Bundling Rules When your pulmonologist suspects that a patient has emphysema, make sure you're prepared to code the tests involved. Your physician will perform either a spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) or a bronchospasm evaluation (94060, Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]).
The bronchospasm evaluation (94060) involves spirometry (94010) taken before and after your physician administers bronchodilation (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered-dose inhaler or intermittent positive pressure breathing (IPPB) device]) to dilate the airways.
Remember that you cannot report both spirometry and bronchospasm tests on the same day - the National Correct Coding Initiative (NCCI) bundles 94010 into 94060. NCCI also bundles several other tests with 94060, including 94375 (Respiratory flow volume loop), 94200 (Maximum breathing capacity, maximal voluntary ventilation), 94770 (Carbon dioxide, expired gas determination by infrared analyzer), 94640 and 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered-dose inhaler or IPPB device).
If your pulmonologist performs the test in the office, you may bill for the bronchodilator medication, such as Albuterol (J7618-J7619). But when a physician performs these tests in a hospital or other outpatient facility, you cannot bill for the supplies because the facility delivers them, says Antoinette Revel, CPC, a coding expert and nurse practitioner for Healthcare Consulting Services in Warrington, Pa. 3. Bill [...]
