Revenue Cycle Insider

Question: A pulmonologist in our practice interpreted the results of a spirometry test performed by another pulmonologist outside of our practice. The report details the spirometry procedure, pre- and post-bronchodilator readings, lung volumes, diffusion, and airway resistance.

What codes will I assign for this service?

Alabama Subscriber

Answer: Since the report indicates spirometry was performed before and after the administration of a bronchodilator, you’ll assign 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) to report the spirometry procedure. This code includes lung volume measurements, so you won’t assign 94150 (Vital capacity, total (separate procedure)) on your claim.

CPT^® guidelines before the pulmonology codes in the code set state that 94060 includes “laboratory procedure(s) and interpretation of test results.” However, you stated the physician only read and interpreted the results and didn’t perform the procedure. In this case, you’ll need to append modifier 26 (Professional component) to 94060.

Important: Reporting 94060-26 is appropriate only when the physician performed a formal interpretation of the spirometry study. If the patient presents for an appointment in the office and the pulmonologist goes over another physician’s formal interpretation, you will not report the procedure separately. Instead, that situation would be factored into determining the medical decision making (MDM) complexity tied to the evaluation and management (E/M) visit.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC