Pulmonology Coding Alert

Question: Can 94150 be billed for peak flow measurement alone without total vital capacity? One of my colleagues is of the opinion that it can be done while I am saying it cannot be. Please tell me who is correct?

Mississippi Subscriber

Answer: During spirometry, the patient inhales and exhales with full effort, and measurements are taken of changes in volume of the respiratory system and airflow rates. The basic measurement of spirometry is the vital capacity, which measures lung volume. Vital capacity is the volume of air that is measured during a slow maximal expiration after a maximal inspiration. Normal range can vary with age, sex and height. Clinical information obtained from an analysis of the expiratory maneuver is most beneficial to the pulmonologist when making a diagnosis and treatment recommendations. To measure expiratory vital capacity, the patient inhales to his or her greatest lung volume and then exhales until air can no longer be expelled. The vital capacity is usually recorded in liters or milliliters.

The spirometer is also used to measure peak expiratory flow rate (peak flow), a measurement of lung mechanics. The peak flow is the highest expiratory flow rate (upper limit of air flow) from the lungs during expiration and occurs early in the expiratory phase.

Vital capacity, as a separate procedure, is more often used for monitoring, as is peak flow. However, CMS assigned a “bundled” status to this service, which means that they do not intend to pay separately for this service.  It is included in the E/M or other PFT (e.g., spirometry) performed on a given date.

Therefore, when your pulmonologist records only the peak flow, you will have to consider this monitoring as an inherent part of the E/M examination, and you should not separately report the test. Count the measurement as part of “the amount and/or complexity of data to be reviewed” medical decision-making element.