Pulmonology Coding Alert

Have you learned the ropes of 94617-94618?

Your practice probably performs pulmonary function tests every day, so coding these services may be instinctive by now. But Pulmonology Coding Alert frequently receives questions about how to report these codes – particularly 94617 and 94618, which debuted just last year.

To get a handle on the best ways to report these services, check out three frequently asked questions that our readers have submitted, along with answers that will allow you to get on the road to proper coding.

Background: You may recall that the AMA added two pulmonary testing codes last year and deleted the previous combined code, 94620 (Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)). Practices must instead report the following codes independently:

• 94617 (Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry)
• 94618 (Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed)

Question 1: What is the Exercise Period for These Codes?

One reader wrote in noting that she was confused by the fact that the new codes do not denote the exercise period assigned to each unit. For instance, there is no description of how many minutes the exercise test should take, and if there’s a threshold after which the practice could report additional units. However, the AMA cleared up that confusion back when the codes debuted.

“The exercise period is not defined in codes 94617 and 94618,” the AMA said in the October 2017 edition of CPT^® Assistant. “A test described by one of these codes is reported once per session.”

Therefore, if you perform the bronchospasm exercise test described in 94617 and you separately perform a six-minute walk test, you’ll bill just one unit of each test. The most recent edition of the Correct Coding Initiative (CCI) (version 25.2) does not bundle these services together, so you should be able to report both without having to employ a modifier.

Question 2: Can We Separately Report Oximetry, Titration?

Several readers wrote to Pulmonology Coding Alert asking whether oximetry and titration are separately billable during the six-minute walk test. However, you shouldn’t separately report those services, according to the AMA.

In fact, the code descriptors specifically state what the codes include, which for 94617 are spirometry, ECG records, and pulse oximetry. For 94618, that would include measuring the heart rate, oximetry, and oxygen titration, when performed.

Question 3: Which Diagnosis Codes Apply?

Medicare has issued several coverage determinations regarding the new codes, most of which list the applicable diagnoses that are covered. Although you should always select the most accurate diagnosis code from the patient’s record and not from the list of payable diagnoses, it’s important to know which ICD-10 codes are payable for these services.

For instance, Noridian Medicare lists the following, among others, as payable diagnoses for 94617-94618:

• E66.2 (Morbid (severe) obesity with alveolar hypoventilation)
• J45.990 (Exercise induced bronchospasm)
• R06.02 (Shortness of breath)
• R06.09 (Other forms of dyspnea)
• R06.2 (Wheezing)
• R06.82 (Tachypnea, not elsewhere classified)
• R06.83 (Snoring)
• R06.89 (Other abnormalities of breathing)
• Z79.899 (Other long term (current) drug therapy)