Pulmonology Coding Alert

Question: A patient reported to our office with wheezing, shortness of breath, and extensive rashes. Our pulmonologist ordered simple spirometry, ice cube skin test, and a scratch/prick test? How should I code this encounter?

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Answer: You should report the spirometry with 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). Spirometry will measure the functionality of the lungs (also known as a Pulmonary Function Test or PFT). It measures the flow and volume of air during inhalation and exhalation.

There is no CPT® code for ice cube test. Most payers may consider it part of E/M visit. An ice cube challenge test is useful in differentiating between cold-induced urticaria (hives) and exercise-induced anaphylaxis. This test entails the application of an ice cube for a non-standardized time interval followed by a period of rewarming. Patients with idiopathic cold urticaria develop a wheal at the ice cube site after the skin is rewarmed.

You can report the scratch test (prick test) with CPT® code 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests). Percutaneous (scratch, prick, or puncture) tests are performed for inhalant allergies and for suspected food hypersensitivity. Areas on the patient’s skin are marked with a pen (usually on the back or forearm) to identify each allergen or each allergens panel (A, B, etc.) that will be tested. A disposable pricking device is then used so the extract can enter into the outer layer of the skin, called the epidermis.

Tip: Bear in mind that each substance counts as a separate test. Be sure to code for each allergen administered by putting the number in the “units” field of your claim form.

Remember to be very extensive with your documentation to show the patient’s documented symptoms, exact number of allergens tested, physician’s notes etc. Do include results of initial screening and patient’s history.