Pulmonology Coding Alert

Computer-enabled devices capable of telephonic spirometry have been used for lung-transplant patients for up to 10 years for the daily evaluation of a patient's condition and to help prevent early rejection of the new lung. The medical necessity of this daily evaluation spurred treatment centers to rally for a set of codes (94014-94016) that would be billable, and payable by Medicare:

94014 patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic    recalibration and physician review and interpretation

94015 ... recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration

94016 ... physician review and interpretation only.
Even though there has been coverage for this type of professional evaluation since 1999, the field of reimbursement for telephonic spirometry is very narrow and specific.
The Whys and Hows of Telephonic Spirometry
At-home monitoring devices can provide a physician with life-critical information daily. The measurements show a physician how efficiently a patient can force air out of the lungs and lend important data to asthma management.
 
Pulmonologists most commonly use spirometers to measure pulmonary lung function of forced vital capacity or total volume of air expired (FVC), forced expiratory volume in one second (FEV1) or forced expiratory flow (FEF). And they use peak-flow meters to analyze the peak expiratory flow rate (PEFR) of a patient (the fastest rate at which air can move through the airways during forced expiration).
 
At a predetermined time each day, the patient records his or her pulmonary function, and the results are stored in a small computer that is part of a spirometer. The data are downloaded via modem from the spirometer's computer to a remote computer at the physician's office or medical center. The information is trended and analyzed as complete spirometric tracings to identify problems like rejection for a lung transplant (V42.6), respiratory function (asthma, 493-493.90) or bronchiolitis obliterans (996.84) following a lung transplant.
Get Complete Trace Information
The essential elements for all Medicare reimbursement of patient-initiated at-home asthma management are complete spirometric tracings, which are reimbursed by Medicare monthly, not daily. Tracings are comprehensive measurements of the patient's pulmonary function such as a spirogram or flow-volume loop, i.e., specific tests, not just single, random numbers. This service is paid by Medicare only if the telephonic transmission of spirometric tracings is present in a composite report that documents and interprets a patient's respiratory data during a 30-day period. These tracings must be analyzed and documented.
 
The composite report generated by the physician must be maintained in the patient's record. This protects the physician and is required for an insurance-carrier audit.
 
"Coders need to be sure that there is a written interpretation by the [...]