Pulmonology Coding Alert

And don't overlook location of test administration to increase coding accuracy

If you find appending modifiers -26 and -77 challeng-ing, look carefully at the services your pulmonologist actually performed during diagnostic testing.

When the pulmonologist legitimately provides only the interpretation and report for a diagnostic study, you must still remember to append modifier -26 (Professional component) to the appropriate CPT code to describe the test, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.

Appendix A ("Modifiers") of CPT explains that some procedures are a combination of a technical component and a physician (or professional) component. In such as case, you should bill for both components.

For example, if the pulmonologist provides both components of the service, such as the administration and reading for a pulmonary function test with privately owned equipment, he may report the appropriate CPT code with no modifiers. Equipment May Make All the Difference for -26 But "When the physician component is provided separately, the service may be identified by adding modifier -26 to the usual procedure code," CPT specifies.

Don't miss: The facility providing the equipment may claim the technical component of the service (the cost of equipment, supplies, technician salaries, etc.) by reporting the appropriate CPT code with modifier -TC (Technical component) appended.

Example: If the pulmonologist does not own the equipment and only provides the interpretation and report for a diagnostic test such as a pulmonary function test, you must report the spirometry code (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) with modifier -26 (94010-26).

If the pulmonologist provides the service in a facility, the facility should report 94010-TC to capture the technical components.