Pulmonology Coding Alert

Question: Does Medicare have guidelines for frequency of spirometry, or does it depend on disease status?

Texas Subscriber

Answer: Frequency rates regarding billing have not been established for 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). There is no global period, which means you can bill the procedure more than once in a given day, provided theres medical necessity, such as progressive shortness of breath.

There are also no frequency guidelines for the following transtelephonic (patient-initiated) spirometry codes.

However, specific requirements have been initiated.

94014 patient-initiated spirometric recording per 30-day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation

94015 recording [includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration]

94016 ... physician review and interpretation only.

Several diagnoses may be used with them. They include, but are not limited, to the following:

The patient must have severe asthma with dyspnea at rest

FEZ-1 of less than 40 percent, predicted after bronchodilator administration

Evidence of end-stage disease by any one of the following: hypoxemia at rest, hypercapnea, secondary polycythemia, or core pulmonal/right heart failure determined by EKG, echocardiogram or cardiac catheter.

A spirometry code may only be used if the patient has been hospitalized twice or visited the emergency room three times in the past 90 days.

Note: Check with your local carrier for their specific requirements.