Pulmonology Coding Alert

You can get paid separately for methacholine challenge tests (94070) and spirometries (94010) conducted on the same patient, but the tests must take place on separate encounters, and the challenge is providing supporting documentation.

Same Day vs. Different Day

Debra Anderson, a 13-year coding consultant with Salem Pulmonary Associates in Salem, Ore., says the encounters can take place on the same day as long as the documentation shows they were done separately. She states that spirometry can be billed if it is administered during separate encounters with the same patient. Its appropriate to bill for a spirometry done the day before or on the morning before an afternoon methacholine test is done.

But John S. Burns, RMC, a coder with the Medical Management Institute, a medical practice consulting firm in Alpharetta, Ga., says the Correct Coding Initiative (CCI) guidelines issued by the Health Care Financing Administration state that spirometry (94010, spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) is included in the codes for methacholine challenge tests. Spirometry is always bundled into 94070 (prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) and should never be coded separately, says Burns. He notes that an exception to this would be if the spirometry is done on a different day.

Adding Modifier -59 with Proper Documentation for Time

Anderson advises adding modifier -59 to the spirometry. The CPT states that modifier -59 is a distinct procedural service: For use when one procedure was distinct or independent from other services performed on the same day.

This lets the insurance company know theres something going on [with the patient]that this spirometry was done separate from the methacholine challenge, she explains. Carriers will request chart notes to determine why you performed a spirometry and then a methacholine challenge, adds Anderson, citing another reason for adding the -59 modifier to your spirometry.

Its critical to document your time, she adds. Say you did a spirometry in the morning, at 9:10 a.m. for dyspnea. If the patient returned that afternoon and ended up with a methacholine challenge because she was having exacerbation of her congestive obstructive pulmonary disease, you need to record the time the challenge was administered. You show the two different times and add -59 because the modifier is definitely contingent on a time factor.

Note: Burns adds that allergy tests (95070, inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) can only be billed and reported on the same day as 94010 if the services are performed distinctly of each other. If both [...]