Pulmonology Coding Alert

Question: Some of our chronic obstructive pulmonary disease (COPD) or asthma patients require the administration of a bronchodilator. Sometimes the physician performs spirometry before and after administering the bronchodilator to check the lung strength of the patient. Should I report 94640, 94010 and 94010-76 (Repeat procedure by same physician) or 94060 alone in this case?

Missouri Subscriber

Answer: If the physician performs spirometry (94010) in addition to bronchodilator administration, you should report 94640 separately because it is not included in the spirometry procedure.

A physician typically performs bronchospasm evaluations (94060, Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) for patients with chronic respiratory symptoms. Physicians use bronchospasm evaluations to identify the extent of obstruction present in the airways, if any, and to measure the response to treatment.

A physician performs spirometry before and after the patient uses bronchodilator to assess airflow obstruction. But you shouldn't report spirometry separate from the bronchospasm evaluation.

Bronchospasm evaluations are diagnostic because they assist the physician to confirm disease or evaluate the appropriateness of treatment. If the physician administers the bronchodilator to a patient with a known disease who presents with acute wheezing (786.07) and shortness of breath (786.05) to relieve acute obstruction (i.e., acute exacerbation), you should report 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]). This procedure is therapeutic because it assists in treating the patient's acute condition.