Pulmonology Coding Alert

Question: I have a report of a patient with documented asthma and shortness of breath, and the pulmonologist wants the patient to undergo spirometry testing before and after bronchodilator. I know the procedure code is 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration), but is there an easy way to tell whether the carrier (TrailBlazer Health) accepts the diagnosis code that proves medical necessity for this service?


Texas Subscriber


Answer: Unfortunately, to stay current on your payers' policies, you have to do a little digging. And because CMS has made a point of going paperless, you have to be doubly vigilant in checking for Medicare and Medicaid online bulletins. Luckily, some carriers make it easy to see the latest news -- for instance, Medicare carrier TrailBlazer Health in Texas sports a Web site with a "What's New" column.

1. At trailblazerhealth.com, click on "Texas" under "Part B" on the left side of the screen. Then click on "LCD (Local Coverage Determination)" in the left column. You can search by the name of the procedure or the CPT code.

2. For this procedure, type 94060 into the search field and click the "Find It" button. This brings up a link to the single LCD for this code, and when you click on that link you'll see the LCD, "Pulmonary Function Testing."

 3. Scroll down past the explanation of the procedures to the lists of exactly which CPT codes you may use to report this service, which in this case includes 94060, and lists which diagnosis codes prove medical necessity. Codes 493.90 (Asthma, unspecified; unspecified) and 786.05 (Shortness of breath) are on the list, so you can trust that you are reporting a code combination that TrailBlazer will pay.

To keep tabs on upcoming edits, check your major local and national payers' as well as Medicare's newsletters and policies the first week of every month.