Pulmonology Coding Alert

Check out these quick tips on how to bill 94617-94618.

Much of January is already behind us, which means chances are strong that your practice has already begun reporting the new pulmonary testing codes. If you've faced any confusion over them, now is a good time to check out a few quick tips that will help ensure that you're on the straight and narrow.

Background: As most readers are aware, the AMA added two pulmonary testing codes (94617-94618) to CPT^® this 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]). The reason CPT^® deleted 94620 was because it described two separate tests frequently used to evaluate patients for dyspnea: Pre- and post-exercise spirometry, and the six-minute walk test. Practices can now 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 (e.g., 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed

Tip 1: Report One Code Per Session

Some coders have been 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 has cleared up that confusion.

"The exercise period is not defined in codes 94617 and 94618," the AMA said in the Oct. 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) does not bundle these services together, so you should be able to report both without having to employ a modifier.

Tip 2: Know What's Included in 94617-94618

Pulmonary practices may think they're going above and beyond when performing things like oximetry and titration during the six-minute walk test, but you shouldn't separately report those services, according to the AMA.

"Code 94617 should be used to report exercise testing to identify bronchospasm and includes a number of pulmonary tests and electrocardiographic recordings (ECG)," the CPT^® Assistant article notes. "Code 94618 should be used to report assessment of pulmonary stressing, which includes measurements of heart rate and oxygen levels (oximetry and oxygen titration), when performed."

Ensure You Link to Accurate ICD-10 Codes

Medicare has already 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