Pulmonology Coding Alert

Knowing how to balance your billing for the numerous pulmonary function tests (PFTs) required to diagnose emphysema can mean the difference between reimbursement success and failure.

Emphysema (492.0-492.8) is a form of chronic obstructive pulmonary disease, or COPD (496), characterized by irreversible airflow obstruction. A patient often presents in the office with a variety of symptoms, including shortness of breath (786.05), wheezing (786.07), breathlessness (786.09), and sometimes even renal insufficiency (593.9) or congestive heart failure (428.0).

Given these symptoms, the pulmonologist has to perform numerous tests to properly diagnose the disease, including PFTs, chest x-rays, and stress tests, says Debbie Tiesmeyer, CPC, a practice coder at Deborah Heart & Lung Center in Browns Mills, N.J. It can be difficult to determine the level of E/M code that fits these services. Until the physician diagnoses emphysema, you should code for the presenting symptoms to support the level of E/M care. Once he establishes the diagnosis of emphysema, however, you should report the appropriate ICD-9 code for this disease. Weigh Spirometry Carefully Two of the more common PFTs performed on suspected emphysema patients are 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). The bronchospasm evaluation involves spirometry (94010) taken before and after the physician administers a bronchodilator (94640) to dilate the airways.

The Correct Coding Initiative bundles 94010 into 94060, so you cannot report both tests on the same day. Remember that CCI bundles several other tests with 94060 that include:
94375 Respiratory flow volume loop
94200 Maximum breathing capacity, maximal voluntary ventilation
94770 Carbon dioxide, expired gas determination by infrared analyzer
Inhalation treatment and demonstration (94640, 94664). Along with the bronchodilation service code, you can bill for the bronchodilator medication under certain circumstances using the appropriate HCPCS code, such as J7618 for Albuterol. However, when the physician performs the test in a hospital, you would not bill for these supplies, Tiesmeyer says. Bundles Pervasive With Other PFTs The pulmonologist will often need to order various other diagnostic tests and PFTs. He can order a chest x-ray and diffusing capacity test, such as 94720 (Carbon monoxide diffusing capacity [e.g., single breath, steady state]). Another option is a lung volume test like 94260 (Thoracic gas volume) or 94350 (Determination of maldis-tribution of inspired gas: multiple breath nitrogen washout curve including alveolar nitrogen or helium equilibration time). However, Medicare considers these PFTs bundled with spirometry.

When performing these tests on the same day as spirometry, only report 94010. Some practices mistakenly believe you can bill for 94200 (Maximum breathing capacity, maximal voluntary ventilation) with spirometry if you [...]