Pulmonology Coding Alert

Proving medical necessity for at-home spirometry can be a challenge but if you know some home-oxygen-testing fundamentals, youll be able to conquer that challenge and take advantage of Medicares increases for 94014, which start in July. Coding experts suggest the following dos and donts for accurately applying the at-home test code:
Do
 
1. Do meet several requirements from which you can select secondary diagnoses (asthma or lung transplant status should be listed first): The patient presents with severe asthma with dyspnea at rest; the patient produces forced expiratory volume in the first second (FEV-1) of less than 40 percent, predicted after bronchodilator administration (measured 14 days before or after ER visit or hospitalization); evidence indicates an end-stage disease by any one of the following: hypoxemia (799.0) at rest, secondary polycythemia (289.0), or cor pulmonale (416.9)/right heart failure (428.0) determined by electrocardiogram, echocardiogram or cardiac catheter.
 
2. Do use an at-home spirometry to measure a patients pulmonary lung function, which gauges forced vital capacity or total volume of air expired (FVC), FEV 1 or forced expiratory flow (FEF). Further, use peak-flow meters to analyze a patients peak expiratory flow rate (PEFR), the fastest rate at which air can move through the airways during forced expiration.
 
3. Do use 94014 for extreme cases. At-home oxygen testing is not intended for the average asthmatic. Pulmonologists use home-based spirometry as a surveillance method to prevent acute situations in the patient with chronic asthma (493.xx) or intercurrent upper respiratory infections (465.9) or following a lung transplant (V42.6), says Carol Pohlig, BSN, CPC, RN, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. Also, within a 90-day period, the patient must have been hospitalized twice or visited the emergency room three times.
Dont
 
1. Dont assume that you will be paid separately for 94015 or 94016. Also, be aware that some private carriers may deny payment for at-home spirometry altogether, regardless of how consistently and accurately you bill. For instance, Aetna states that it does not cover home-oxygen testing, citing inadequate evidence that such monitoring will improve patient care.
 
2. Dont bill for 94014 inconsistently from month to month. Instead, report the services at scheduled intervals to help prevent overlapping claims that result in denials, Pohlig says. For example, dont bill on the last day of one month and then again in the middle of the next month.
 
3. Dont submit a bill twice for 94014 in a 30-day period you will be hit with denials, Pohlig says. Your pulmonologist should perform both the technical and professional component within a 30-day period.