Pulmonology Coding Alert

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.

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. 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.

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): 

 The patient must have severe asthma with dyspnea (786.09, Dyspnea and respiratory abnormalities; other; 786.00, Respiratory abnormality, unspecified) at rest. 
 Forced expiratory volume (FEV-1) of less than 40 percent, predicted after bronchodilator administration (measured 14 days before or after emergency department visit or hospitalization). 
 Evidence of end-stage disease. For example, an electrocardiogram, echocardiogram or cardiac catheter detects hypoxemia (799.0) at rest, secondary polycythemia (289.0), cor pulmonale (416.9), or right heart failure (428.0).

When the patient doesn't have [...]