Pulmonology Coding Alert

Question: Can I separately report multiple spirometries in the office? Washington Subscriber Answer: Medicare has not established frequency rates for billing spirometry (94010). There is no global period, which means you can bill the procedure more than once on a given day, if there is medical necessity. For example, suppose a pulmonologist sees a patient who presents with a muscular abnormality or other condition that requires multiple spirometries. The physician performs spirometry in the supine and upright position. In this case, you should code the comorbid conditions and include this information in the pulmologist's report. Append modifier -76 (Repeat procedure by same physician) to the subsequent spirometry to indicate the procedure was repeated after the initial service.

Be aware, however, that local carriers may place restrictions on repeat spirometries. According to Palmetto GBA's LMRP, "Indications for repeat testing include preoperative evaluation in patients with known lung disease or for tracking pulmonary expressions of diseases." Repeat spirometry is also allowed to quantify responses to therapy, to make early diagnoses of lung injury after occupational exposures and drug or radiation therapy, and to evaluate response to bronchodilator therapy or steroids.

"Repeat spirometry (94010, 94060, 94150-94375) performed for patients on bronchodilator therapy presenting without new symptomatology is considered routine screening [and] is not covered," as stated by Palmetto's LMRP. For patients with chronic cough, PFTs are included in the initial workup, and repeat procedures should not be performed without additional symptomology or failure to respond to a prescribed treatment. Likewise, Cahaba GBA's LMRP holds that repeat testing requires documentation of medical justification such as unexpected changes in symptoms of respiratory disease, evaluation of ongoing therapy to determine changes, and monitoring signs of lung-transplant rejection.

Your best bet is to ask your local carriers if they have established local policies on repeat spirometric testing. If they have not or if you qualify under their standards, then you should follow the above guidelines for reporting these tests. Make sure you follow the payer's policy regarding medical necessity and documentation.