Pulmonology Coding Alert

Question: Can I bill 94016 with a complete set of PFTs including 94060? I know of a few offices billing these codes together and getting paid for both.

Maine Subscriber

Answer: Yes, you can bill 94016 (Patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only) with 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration). CPT 94014-94016 is also referred to as transtelephonic spirometry.

How 94016 works: At-home monitoring devices can provide a physician with life-critical information daily. The measurements show a physician how efficiently a patient can force air out of the lungs and lend important data to asthma management.

Pulmonologists most commonly use spirometers to measure pulmonary lung function of forced vital capacity or total volume of air expired (FVC), forced expiratory volume in one second (FEV1) or forced expiratory flow (FEF). And they use peak-flow meters to analyze the peak expiratory flow rate (PEFR) of a patient (the fastest rate at which air can move through the airways during forced expiration).

At predetermined time intervals, the patient records his or her pulmonary function, and the results are stored in a small computer that is part of a spirometer. The data are downloaded via modem from the spirometer's computer to a remote computer at the physician's office or medical center. The physician, then, analyzes the information as complete spirometric tracings to identify problems like rejection for a lung transplant (V42.6, Lung replaced by transplant), respiratory function (asthma, 493-493.9x) or complications (e.g., 996.84, Complications of transplanted lung) following a lung transplant. Some payers do not provide coverage for this service whereas others have established criteria for coverage (e.g., www.highmarkbcbswv.com/medpolicy/M-19-009.html):

Following lung transplantation to monitor for problems such as rejection, infection, or bronchiolitis obliterans; or

For patients diagnosed with severe asthma who meet all of the following criteria:

• 1. Severe asthma, with both: dyspnea at rest, and FEV1<40 percent predicted after bronchodilator administration.
• 2. Two hospitalizations or three emergency room visits in the past 90 days for poorly controlled asthma or intercurrent respiratory infections.
• 3. Evidence of end-stage disease by any one of the following: hypoxemia at rest (pO2<55mmHg or O2sat<88 percent); hypercapnia (pCO2 >50mmHg); secondary polycythemia (HgB>18g/dl); or cor pulmonale/right heart failure determined by EKG, echocardiography, or cardiac cath.