Pulmonology Coding Alert

Learn the difference between manual and mechanical chest PT.

Throughout the course of the disease, pulmonologists order and perform a variety of tests to evaluate a patient’s cystic fibrosis (CF) condition. Pulmonary physicians also coordinate care and provide counseling to address any pulmonary issues caused by the disease.

Read on to know how to code repeated pulmonary function tests (PFTs), lab tests, and chest physiotherapy (PT) services.

Code CF Condition Monitoring Through Several Methods

In addition to frequent evaluations, pulmonologists use repeated PFTs, such as 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) and 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration), to evaluate the patient’s lung function.

Pulmonologists may also obtain sputum (mucus) cultures, coded by the lab to 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates), 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types), or 87081 (Culture, presumptive, pathogenic organisms, screening only), “to ensure there is no bacterial growth that could cause complications,” 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.

Beware Spirometry Test Code Bundling During Treatment Assessment

For patients diagnosed with CF, “spirometry is used throughout the course of care to measure lung function,” Pohlig says. Pulmonologists can perform spirometry to evaluate a patient who’s experiencing symptoms after treatment starts, to assess a patient’s response to new treatments, or to determine the stability of lung function and the appropriateness of CF management. Spirometry is reported as 94010.

Additionally, if a physician performs spirometry before and after administering a bronchodilator, you’ll assign 94060. CPT^® code 94060 includes all the work of 94010 plus the evaluation of the patient before and after introducing a bronchodilator, which allows the pulmonologist to better analyze the patient’s condition and treatment effects.

A pulmonologist may perform several other services in addition to spirometry, and many of them are bundled into 94060 according to the Medicare National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit pairs.

Codes bundled into 94060 according to NCCI include:

• 94200 (Maximum breathing capacity, maximal voluntary ventilation)
• 94375 (Respiratory flow volume loop)

If you see these services listed in the provider’s documentation, remember that the separate codes cannot be reported on the same date in addition to 94060.

CPT^® code 94200 has a modifier indicator of “1” in the NCCI PTP edits. This means 94200 can be reported separately from 94060 if the physician performed the procedure as a distinct service separate from the same testing. To report the codes separately, you’ll append a modifier to override the edit. For instance, you may append modifier 59 (Distinct procedural service) or one of the Medicare-sponsored X-modifiers, such as XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service), depending on your individual payer’s preferences.

Learn How to Code Chest Physiotherapy

“If the spirometry results show a decrease in lung function, the physician can respond with additional treatments to try to improve function,” Pohlig says. Additional treatments can include chest PT, autogenic drainage, or other airway clearance techniques (ACT). Autogenic drainage, also known as self-drainage, requires different breathing speeds to help move mucus.

Chest PT involves manual or mechanical chest wall manipulation to help mobilize a patient’s lung secretions to aid in clearing mucus from the patient’s airways. According to CPT^® guidelines, manual techniques involve “cupping, percussing, and use of a hand-held vibration device,” while a mechanical technique uses the “application of an external vest or wrap that delivers mechanical oscillation.”

If your pulmonology practice provides manual chest manipulation, you’ll assign 94667 (Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation) or 94668 (… subsequent). But if the practice provides mechanical chest manipulation, you’ll assign 94669 (Mechanical chest wall oscillation to facilitate lung function, per session). Payers may restrict the use of these codes to certain providers or sites-of service.

Get Specific With CF ICD-10-CM Codes

As the provider monitors the patient’s condition and confirms a CF diagnosis, you’ll look to the E84.- (Cystic Fibrosis) code family to report the diagnosis. While parent code E84.- covers the general condition, you’ll need to dive deeper into the code family to find a specific code that applies to the diagnosis. ICD-10-CM category E84.- carries a 4th character required icon. That character specifies any additional manifestations presenting alongside the condition.

The codes for cystic fibrosis are below. Note that E84.1- requires an additional character to be complete:

• E84.0 (Cystic fibrosis with pulmonary manifestations)
• E84.1- (Cystic fibrosis with intestinal manifestations)
• E84.8 (Cystic fibrosis with other manifestations)
• E84.9 (Cystic fibrosis, unspecified).