Pulmonology Coding Alert

Tread cautiously while pairing 94010 with 94060 or 94070.

Pulmonary function testing can throw challenges at you, and if you are not careful, you may unintentionally set yourself up for denials. Read on to know more about these codes and learn from examples — how to choose the most appropriate from amongst them.

Background: PFT, or pulmonary function testing, in simple words, is an umbrella term encompassing the objective measurement of various parameters of lung function, such as spirometry, lung volume test, lung compliance test, and more. You may bill for PFTs with the appropriate CPT^® code from the range 94010- 94799. Here is a brief analysis of the codes we commonly come across in PFT coding.

Know the Nuances of Spirometry

Spirometry code 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) measures expiratory airflow and volumes, including its graphic record, and forms the basis of most pulmonary function testing. Respiratory disorders such as COPD (Chronic Obstructive Pulmonary Disease), asthma, pulmonary fibrosis, etc. can be evaluated via spirometry.

Basics: Spirometry is a test used to measure the functionality of the lungs. It measures the flow and volume of air during inhalation and exhalation. The result is represented in a graphic format where the X–axis represents the volume of air and the Y–axis represents the rate of airflow.

When spirometry is performed before and after administration of a bronchodilator, report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration).

Example 1: A patient, smoker for 20 years, presents with shortness of breath. The provider, after due assessment decides to perform spirometry. The readings being subject to patient effort, the provider is not satisfied; he therefore gives a bronchodilator to the patient and re-performs the test. As the readings improve, this indicates reversible airflow limitation and the provider diagnoses the patient as probable COPD.

In this scenario, you just need to code 94060. There is no need for 94010, as the initial attempt at plain spirometry turned into a bronchodilator responsiveness test later.

Watch out: You have a myriad of codes available to report specific components of pulmonary function. Since 94010 and 94060 are codes encompassing spirometry per se, you need not separately report the following codes along with them:

• 94150 (Vital capacity, total [separate procedure])
• 94200 (Maximum breathing capacity, maximal voluntary ventilation)
• 94375 (Respiratory flow volume loop)
• 94728 (Airway resistance by impulse oscillometry).

Here’s why: Measurement of vital capacity (94150) is a component of spirometry. Spirometry (94010, 94060) also includes maximal breathing capacity (94200) and flow-volume loop (94375), when performed. 

Caveat: You may report the above codes separately, on a condition that these procedures are performed separately as a standalone procedure, devoid of the spirometry procedure, on that particular visit.

Take the Coding Challenge With 94070

Furthermore, you also come across the methylcholine challenge test 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]). In this procedure, the provider deliberately induces bronchospasm by controlled and measurable exposure to a specific stimulant. He then performs spirometry multiple times to evaluate the lung function under induced bronchospasm.

Example 2: A patient visits the provider with complaints of breathlessness. The provider, after ruling out any red flags, performs spirometry, and the results demonstrates findings within normal ranges. The provider then decides to go on and expose the patient to a bronchial methacholine challenge test, for estimation of lung function under test conditions.

In this scenario, because the provider performed the spirometry first, you may report 94010, followed by 94070. Although these codes are typically bundled, you may still go ahead and report them, provided you use modifier 59 (Distinct procedural service) to the spirometry code.

On the other hand, when the methacholine test precedes the spirometry, you may be able to bill only 94070. The spirometry would not be deemed necessary as, it would not provide any additional, diagnostic information, over and above that already had from the methacholine challenge test 

Furthermore, the code for flow-volume loop, 94375 (Respiratory flow volume loop) is used to identify patterns of inspiratory and/or expiratory obstruction in central or peripheral airways. It is usually bundled with the spirometry codes.

Remember: Read into the extended code descriptors, and follow the “do not code with” dictum faithfully, so as to stay clear on your PFT claims.