Pulmonology Coding Alert

Question: We often perform testing before and after the 6-minute walk test. Are we able to report these tests along with the walk test, or are they bundled?

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Answer: Yes, you may charge pre/post bronchodilation spirometry, 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with modifier 59 (Distinct procedural service) in addition to reporting the six-minute walk test (94620, Pulmonary stress testing; simple [eg, 6-minute walk test, prolonged exercise test for bronchospasm withpre- and post-spirometry and oximetry]) as long as the information you are collecting from the bronchodilation responsiveness testing does not overlap with the 6-minute walk test, since you can only count each piece of data once.

You should also ensure that the documentation reflects that the bronchoresponsiveness testing was completed, rather than a simple inhalation treatment for increased wheezing that can sometimes occur post-test. In the latter scenario, it is more appropriate to report 94620 and 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device).

You may also report codes 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) and 94729 (Diffusing capacity [eg, carbon monoxide, membrane] [List separately in addition to code for primary procedure]) depending upon the lung volumes that the physician measured.

Your documentation for the six-minute walk should include pre- and post-test measurements of oxygen saturation (if taken), height, weight, heart rate, blood pressure, notation of rate of supplemental oxygen, if used, patient's time and distance walked, patient ratings of dyspnea and fatigue, and symptoms experienced.  

You cannot separately report spirometry performed with the simple pulmonary stress testing.