Pulmonology Coding Alert

Question: What is the correct code to bill for the reading of a lung volume report/study? Some carriers say code the reading with 94360, others say use 94240-26. Whats the right answer?

Helen Pinckard
Valley Pulmonary & Critical Care
Decatur, Ala.

Answer: Depends on how youre measuring a lung volume. If youre using a plethysmography, report the procedure as described in the previous answer (above). Although it may be done in conjunction with a plethysmography, code 94360 (determination of resistance to airflow, oscillatory or plethysmographic methods) is not a measurement of lung volume. Code 94240 (functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method) is what youre really doing when measuring the lung volume. If you are having trouble getting reimbursed for interpreting the lung volume study, determine which method you are using, then verify that your place of service and modifiers are correct. If either 94360 or 94240 is performed in your office with your equipment, and the physician is providing a
written interpretation, then bill the appropriate code with no modifier. If the test is being performed at an independent facility, append the -26 modifier to indicate the physician is providing the professional component of the study only.