Pulmonology Coding Alert

Question: When done in office, can we charge for pre/post testing in addition to 6-minute walk? For example, can we code 94060-59, 94726, 94728, 94729, and 94620?

Missouri Subscriber

Answer: Yes, you may charge pre/post bronchodilationspirometry, 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with modifier 59 (Distinct procedural service) in addition to six-minute walk test represented by code 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- 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. “Additionally, ensure that the documentation reflects that the bronchoresponsiveness testing was completed, rather than a simple inhalation treatment for increased wheezing that occurred post-test. In this latter scenario, it is more appropriate to report 94620 and 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]),” explains Carol Pohlig, BSN, RN, CPC, ACS, Senior Coding & Education Specialist at the Hospital of the University of Pennsylvania.

You may also charge codes 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) and 94729 (Diffusing capacity [e.g., carbon monoxide, membrane] [List separately in addition to code for primary procedure]) depending upon the lung volumes measured. However, you cannot code 94728 (Airway resistance by impulse oscillometry), as it is bundled with 94726 and 94060.

Your documentation 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. Guidelines for the six-minute walk test published by the American Thoracic Society provide a sample documentation form. You can find the guidelines at http://www.thoracic.org/statements/resources/pfet/sixminute.pdf.