Pulmonology Coding Alert

Question: My pulmonologist is sending patients for services covered by 94620. He is interpreting the test and reviewing the findings with the patients. Does code 94620 have a reading and interpretation portion or should we just add a 26 modifier?

Mississippi Subscriber

Answer: CPT^® code 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]) consists of both a technical component and a professional component. In case your pulmonologist performs only a review and interpretation of the test findings (professional component), you may bill 94620 with the 26 modifier (Professional component). For the place where the pulmonary stress testing has been performed, you will bill 94620 with the TC modifier (Technical component). If both services (professional and technical component) have been performed at the same place, report 94620 without any modifier.

Caution: If the facility where the patient is receiving the test, contracts with another provider to perform the interpretation, your pulmonologist cannot provide and bill for a separate interpretation. This would be a duplication of services.