Pulmonology Coding Alert

Answer 1: In the scenario presented, the pulmonologist saw an established patient, performed simple spirometry, and used the results as a reason to adjust the patient’s medication. You’ll assign 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.) and 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) to report this encounter.

While 94010 does not have a global period (assigned xxx), one would typically think it does not qualify for modifier. However, the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit pairs bundle 99214 into 94010 with permission to unbundle when appropriate, as in the question’s scenario. Therefore, you will place the appropriate modifier on the bundled service. In this case, 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 99214 to represent that the evaluation and management (E/M) visit is separately identifiable from 94010.

Modify Your Spirometry Code for Repeat Testing

Answer 2: In addition to an appropriate E/M code for new patients, such as 99202-99205 (Office or other outpatient visit for the evaluation and management of a new patient …), you’ll assign 94010 to report the spirometry procedure. You are not able to append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to 94010 for the multiple tests. During testing, technicians must record a “valid” test, which is considered a minimum of three acceptable maneuvers that demonstrate consistent (“repeatable”) results for both FVC and FEV1.

“You also won’t report 94010 twice if the initial testing was incomplete due to equipment failure or if the patient can’t follow the instruction,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

Analyze This EIB Diagnostic Testing Case

Answer 3: This scenario requires two CPT^® codes to report the encounter. You’ll start with the appropriate E/M code, which in this case would be 99204. That’s because the patient presented with an undiagnosed new problem with uncertain prognosis and the provider performed prescription drug management, which satisfies two of the three elements for a moderate level of MDM.

Next, you’ll assign 94617 (Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s)) to report the exercise test to evaluate the patient for bronchospasm.

Prepare to Report Patient-Initiated Spirometry

Answer 4: The established patient presented to the pulmonologist following the patient’s lung transplant to receive equipment and education on how to use the patient-initiated spirometric recording device for 30 days. This procedure is helpful to evaluating the patient’s lung performance following the transplant. You’ll assign 94014 (Patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and review and interpretation by a physician or other qualified health care professional) to report this procedure.

Next, you’ll assign 99214 appended with modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to report the E/M visit via telehealth. However, it is very important that the provider includes an exclusionary statement indicating that the spirometry service was not included in the 30 minutes reported for the visit. Without this statement, the visit will need to be reported on the MDM content included in the note. Keep in mind that when the visit includes the proper time statement, the provider has a choice to report the visit level by MDM or time, whichever yields the more favorable result.

According to NCCI, you will also need to append modifier 25 to the E/M in order to report the separate management provided on the same day as 94014.

Avoid Unbundling Codes That Shouldn’t Be

Answer 5: In this case, you’ll only assign the applicable established patient office/outpatient E/M code. “Code 94150 (Vital capacity, total (separate procedure)) is designated as a ‘separate procedure’ and is therefore bundled into any more extensive respiratory testing,” says Julie Davis, CPC, CRC, COC, CPMA, CPCO, CDEO, AAPC Approved Instructor, risk adjustment manager of Physician Health Partners in Parker, Colorado.

Since 94150 is bundled into E/M codes, you’ll need to consult your individual payer for proper reporting if the total vital capacity is the only service performed during the visit. “The Medicare Physician Fee Schedule designates 94150 with a ‘bundled’ status (B). This means that no separate payment is ever made for 94150,” Pohlig says. “Inclusion of 94150 on certain Medicare policies contradicts the code’s status. It is best to obtain clarification from non-Medicare insurers,” she adds.