Pulmonology Coding Alert

Last year, Medicare split code 94620 (pulmonary stress testing, simple and complex) into two codes. They are: 94620 (pulmonary stress testing; simple (e.g., pro-longed exercise test for bronchospasm with pre- and post-spirometry) and 94621 (... complex [including measure-ments of CO2 production, O2 uptake, and electrocardiographic recordings]). This decision recognized the difference in the resources required by these two stress tests. Walter J. O'Donohue, Jr. MD, FCCP, FACP, a representative to the AMA CPT Advisory Committee for the American College of Chest Physicians (ACCP) and CRT/RUC Committee Chairman of the ACCP, points out that these differences are so vast that one code cannot accurately reflect two such disparate tests. This change has been welcomed by most pulmonologists because it has allowed their practices to realize reimbursement previously lost.  
According to Cynthia Somma, CPC, a coder for the Nassau Queens Pulmonary Associates, a four-physician practice in New Hyde Park, N.Y, "When the two tests were embodied into one code, most practices couldn't meet the requirements to realize reimbursement for their services." She goes on to explain that most pulmonologists perform only the simple test because the complex one is more suited to a hospital or specialized setting due to the time, equipment and level of physician supervision. The requirements, however, of the original code included the more complicated and detailed service for the complex test. As a result, most practices could not meet them and also lost compensation for performing the simple test.   Requirements for Simple Stress Tests   Even though this change in coding has been a marked improvement, coders still need to be aware of the requirements for the procedure and involvement of the pulmonologist for each test to obtain maximum reimbursement.  
The simple pulmonary stress test is usually performed on patients who fall into one of the following categories:   
those with the physical conditions of unexplained shortness of breath, pulmonary hypertension or pulmonary fibrosis;
those undergoing pre-op evaluation for a lung transplant or major lung surgery; 
those undergoing disability evaluation to determine the severity of a disease such as brown lung disease; or 
those undergoing evaluation to determine if they meet Medicare's requirement for supplemental oxygen.   Usually, this test is performed to determine the severity, not the cause, of the patient's condition. One procedure involves measuring lung volumes and flow rates before and after exercise to document bronchospasm.    It requires the general supervision of the pulmonologist as defined by Medicare's revised definitions of physician supervision of diagnostic tests which went into effect in July 2001, meaning that this diagnostic procedure is performed under the physician's overall direction, but his presence is not required during the actual performance of the test, although he [...]