Pulmonology Coding Alert
Base 30-Day Spirometric Recording Reporting on Professional/ Technical Components
Question: Our pulmonologist recently reviewed results of a patient induced spirometric recording that were recorded over a 30-day period. The patient suffers from severe persistent asthma. When I checked through the CPT® coding manual to see how to report this spirometric recording, I could see that there are three codes to report this procedure, 94014, 94015 and 94016. I am not sure as to which code I need to report for the recordings.
Answer: First and foremost, it is essential to understand that Medicare and other carriers may not cover the services under the CPT® code ranges 94014-94016 since their clinical efficacy has not been established.
For this reason, it is best to get the patient to sign an advance beneficiary notice (ABN) from the patient in order to claim for these services in case it gets rejected by the payer. You should also notify to the payer while making a claim to these codes by attaching the modifier GA (Waiver of liability statement on file) to communicate to the payer that you have obtained the ABN from the patient.
While billing out these recordings, you will have to understand to whom the equipment used in the recordings belongs and who provided the interpretation. If your pulmonologist owns the equipment and also performed the interpretations to the spirometric readings, you should report 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 review and interpretation by a physician or other qualified health care professional).
Instead, if the equipment belongs to the facility in which your pulmonologist consults and your pulmonologist only provided interpretations to the readings, you will report only 94016 (Patient-initiated spirometric recording per 30-day period of time; review and interpretation only by a physician or other qualified health care professional) for the services provided by your pulmonologist. The hospital or the facility that owns the equipment will bill out the technical component of the service by reporting 94015 (Patient-initiated spirometric recording per 30-day period of time; recording [includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration]).
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