Pulmonology Coding Alert

Question: We saw a 55-year-old new patient who has been smoking for 30 years. She was referred for consult by her GP after experiencing frequent shortness of breath. The pulmonologist performed a detailed history and an expanded problem-focused exam, and decided that spirometry would help diagnose COPD. The patient had non-optimal readings on the first spirometry, so the physician administered albuterol and re-performed the spirometry. Readings from the second test were greatly improved. The pulmonologist diagnosed the patient with reactive airway disease and probable COPD. Which code(s) should we report?

Answer: For this service, you’ll report the following codes:

• 99241-99245 (Office consultation for a new or established patient office …) for the consult services (if accepted by the payer) or 99201-99205. Although Medicare no longer pays for consul­tations, some private payers will still reimburse you for them.
• 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) for the albuterol-induced spirometry;
• A diagnosis code from the J45.-- (Asthma …) series, depending upon the quality of the asthma and the acuteness of attack.
• J7609-J7613 (Albuterol, inhalation solution…) for the bronchodilator medication, such as Albuterol, if your pulmonologist performs the test in the office.

Hint: The correct code here is 94060 because the spirometry has turned into a bronchospasm test since the physician used an albuterol inhaler during the evaluation. The bronchospasm evaluation (94060) involves spirometry taken before and after your physician administers bronchodilation to dilate the airways.