Pulmonology Coding Alert

Question: Can I bill for a spirogram (94010) and methacholine test (94070) performed on the same patient on the same day?
        
Georgia Subscriber
Answer: Code separately for these tests as long as the spirogram is performed before the methacholine test. For example, if the spirogram is performed on a patient for dyspnea, the results are normal, and a methacholine test is then performed, report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) with modifier -59 (Distinct procedural service) appended to the spirometry code.   
 
The Correct Coding Initiative (CCI) bundled 94010 with 94070, but this can be overridden with modifier -59 when the spirogram is performed first. If the spirogram is taken after a methacholine test, use 94070 only.
 
CMS allows the methacholine tests to be billed with the following ICD-9 codes:

  493.00, 493.10, 493.20, 493.90 Asthma
  786.00-786.09 Respiratory abnormality such as dyspnea, tachypnea, hyperventilation, wheezing and shortness of breath unrelieved by bronchodilator
  786.2 Cough.         

Answers to Reader Questions and You Be the Coder provided by Carol Pohlig RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania in Philadelphia; and Walter O'Donohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP.