Pulmonology Coding Alert

Hint: Ask about test details when your pulmonologist orders PFTs

Pulmonologists often order pulmonary function tests (PFTs) for patients who present to their practices with symptoms such as wheezing and shortness of breath. With so many different pulmonary function tests and so many codes to go along with them, your job can be challenging. Read on to discover expert tips that will keep you from reporting incorrect codes. Don’t Report 94010 and 94060 for the Same Day Two common PFTs that pulmonologists perform are baseline spirometry and spirometry after administration of a bronchodilator. You should use 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurements[s], with or without maximal voluntary ventilation) to report a baseline spirometry test. For spirometry after the administration of a bronchodilator, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post- bronchodilator administration).
 
Because the bronchospasm evaluation involves pre- and post-spirometry, the National Correct Coding Initiative bundles 94010 with 94060. This means that you cannot report them separately when the physician or nurse performs the tests the same day. You should report the single most comprehensive code for the session.
 
Pulmonologists may perform both PFT tests in one day. For example: “When a patient presents with chest symptoms of wheezing, shortness of breath, etc., our physician would most likely order a simple spirometry,” says Mary Beth Wass, MS, CMM, manager of The Asthma & Allergy Center in Papillion, Neb. “If certain measurements were found to be below normal, the patient may be given an inhalation treatment, such as a bronchodilator, followed by another spirometry.” In this case, you should report 94060. Different Diagnosis Codes Help Methacholine Reimbursement When your pulmonologist orders a methacholine challenge test for a patient, you should report 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds). Be sure you also report 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]) for multiple spirometries that measure the methacholine’s impact. You should also submit HCPCS Codes J7674 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg) for the methacholine used in the challenge.

If your pulmonologist needs to determine the patient’s breathing disorder, he may perform a methacholine challenge test. In some cases, a physician may schedule a methacholine challenge for those patients who have a history of shortness of breath and wheezing, but who have no documented reversibility in lung functions, Wass says. After completion of the study, the physician may be able to confirm that the patient has reactive airway disease.
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