Pulmonology Coding Alert

Did you use modifier 59 (Distinct procedural service)? Your pulmonary stress test (PST) claim could fall into limbo land if you overlooked this key element.

Scenario: A 57-year old patient presents to your pulmonologist's office with dyspnea (786.09, Dyspnea and respiratory abnormalities; other) and cough (786.2) after she walks several city blocks. She is sent for spirometry and her resting spirogram comes back normal. The pulmonologist orders a simple pulmonary stress test. She experiences dyspnea as she walks on the treadmill, so the pulmonologist orders a repeat spirogram to document the patient's exercise-induced bronchospasm.

Solution: The initial spirometry came out normal. Still, the patient's history was consistent with exerciseinduced bronchospasm, which would establish medical necessity for the PST. You should report the initial spirometry as a separate service by appending modifier 59 (94010-59) and use 94620 to report the simple pulmonary exercise stress test.

Smart move: Enclose a copy of the patient's records to the claim to establish medical necessity, but prepare yourself for an appeal.

Furthermore, you should link 786.09 to the initial spirometry code 94010, and 493.81 (Exercise-induced bronchospasm) to 94620.

ICD-10-CM: With the new system, you will report 493.81 as J45.990 (Exercise induced bronchospasm).