Tip: Report patient-initiated spirometry only once a month Think you know everything you need to know about patient-initiated spirometry (94014)? Think again. Many pulmonology coders are unaware of Medicare's strict documentation and diagnosis guidelines for reporting code 94014. Distinguish Your Patient-Initiated Spirometry Pulmonologists use patient-initiated spirometry to analyze lung function in patients with severe asthma (493.xx), intercurrent upper respiratory infections (465.9), or following lung transplants (V42.6), says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania's hospital in Philadelphia. Physicians should not prescribe at-home spirometry for the average asthmatic, she says. Prove Medical Necessity You should use patient-initiated spirometry for patients who've been hospitalized twice or visited the emergency department three times in the past 90 days for poorly controlled asthma and other respiratory infections. Report 94014 Once a Month Although your pulmonologist may receive spirometric data several times a month, you should report 94014 only once a month. The code represents a spirometric recording for a 30-day period, according to the CPT definition.
The lowdown: Patients perform spirometry (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 physician review and interpretation) in their homes, and then transmit the data to the physician through the telephone to a device in the physician's office, says Alan Plummer, MD, chief of pulmonary disease, allergy and critical care at Emory University Hospital in Atlanta. The physician then interprets the data, he adds.
Doctors use home-based spirometry for patients who've had lung transplants. Typically, the patient's condition is unstable enough for the physician to alter therapy to stabilize the patient, Plummer says.
What to do: You should assign 94014 per 30-day period for these home-based spirometric services.
By contrast, pulmonologists typically administer baseline spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) to evaluate abnormal conditions, such as wheezing (786.07). The procedure also monitors patient progress and lung function.
Medicare pays about $50 for 94014, which is $15 more than it pays for 94010. But some private payers, such as Aetna in Hartford, Conn., consider patient-initiated spirometry investigational and will not pay for the procedure.
Remember, for you to report 94014 correctly, the patient's conditions should be quite unstable, Pohlig says.
And, your pulmonologist must meet several payer requirements from which he can select secondary diagnoses (list asthma or lung transplant status first):
When the patient doesn't have severe asthma, your physician may use patient-initiated spirometry to monitor lung transplant patients (V42.6) for rejection (996.84) or bronchiolitis obliterans (491.8), Pohlig says.
Watch out: If you miscalculate and assign 94014 twice in the 30-day period, your payer will likely deny your claim, Pohlig says.
Tip: To avoid confusion, report 94014 at the same time each month and be sure to indicate the correct range of dates as to not overlap them. Reporting these services at scheduled intervals helps prevent overlapping claims that could result in denials, Pohlig says.
For example, avoid billing on the last day of one month and then following that with a bill in the middle of the next month.
And, when you report patient-initiated spirometry, you should use only global code 94014, which includes both technical and professional portions. Most payers will deny component codes 94015 (Patient-initiated spirometric recording per 30-day period of time; recording [includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration]) and 94016 (... physician review and interpretation only).