Pulmonology Coding Alert

Question: I have documentation stating the physician performed cardio­pulmonary exercise testing and captured minute ventilation, CO2 production, O2 uptake, and electrocardiographic recordings. I’m new to pulmonology coding — could you explain the different procedure codes I’ll need to report this encounter?

Kansas Subscriber

Answer: You need to assign only 94621 (Cardiopulmonary exercise testing, including measurements of minute ventilation, CO2 production, O2 uptake, and electrocardiographic recordings), which includes all the measurements you mentioned in your question. A provider uses cardiopulmonary exercise testing (CPET) to assess the patient’s lung and heart function. By measuring minute ventilation (volume of gas exhaled), the physician can evaluate the ventilation to perfusion ratio and assess the patient’s pulmonary function.

Several parenthetical notes sit under 94621’s descriptor to offer additional instructions. These notes direct you to not code 94621 with the following procedure codes since they are inherently part of the CPET:

• 93000-93010 (Electrocardiogram, routine ECG with at least 12 leads …)
• 93040-93042 (Rhythm ECG, 1-3 leads …)
• 93015-93018 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress …)
• 94680-94690 (Oxygen uptake, expired gas analysis …)
• 94760-94761 (Noninvasive ear or pulse oximetry for oxygen saturation …)

Since CPET includes cardiac and skeletal system functioning, the testing is more useful than pulmonary stress testing alone.