Pulmonology Coding Alert

Question: When billing multiple components of a pulmonary function test, do I have to use a modifier 51 on the lines other than the first? Also, let me know when I need to use modifier 26 for a pulmonary function test?

Cincinnati Subscriber

Answer: As per Correct Coding Initiative (CCI) edits, when your pulmonologist performs a bronchospasm evaluation (94060, Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) as part of the pulmonary function tests, these following services are bundled into it:

• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)
• 94375 (Respiratory flow volume loop)
• 94200 (Maximum breathing capacity, maximal voluntary ventilation)
• 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])
• 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device)
• 94770 (Carbon dioxide, expired gas determination by infrared analyzer)

You can report any other nonbundled series of pulmonary function tests provided by your pulmonologist with their respective codes. As most payer guidelines do not require modifier 51 (Multiple procedures), you do not have to use it to separate the different components of the pulmonary function tests. However, if your payer guidelines do specify the use of modifier 51, you can use it appropriately.

You have to append modifier 26 (Professional component) only if your pulmonologist is carrying out the pulmonary function tests in a facility-based setting or a private office where the equipment is not owned or leased by him. By appending the modifier you will be informing the payer that your pulmonologist is only providing interpretations to the test and the facility will provide a claim for the technical component of the service.