Pulmonology Coding Alert

Question: How should I code for the professional component (the interpretation of the test by the physician) of 94010 or 94060?


Idaho Subscriber

Answer: Because the pulmonary function test (PFT) codes that you mention contain both a professional and technical component, you can use modifiers 26 (Professional component) and TC (Technical component) to bill the appropriate portions of 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and 94060 (Bronchospasm responsiveness, spirometry as in 94010, pre- and postbronchodilator administration).

When you are not billing for the entire service (which includes the technical and professional portions), report the appropriate code with a modifier appended to describe the pulmonologist's portion of the rendered service:

Scenario 1. To bill for the professional component only: When the test is provided in an outpatient hospital where the pulmonologist does not employ the staff or own the equipment, the only charge reported by the physician would be 94010 with modifier 26 (or 94060-26) appended to indicate the professional component. "The total relative value units (RVUs) for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense," according to "Attachment A" of the 2006 National Physician Fee Schedule Relative Value File.

The facility bills 94010-TC (or 94060-TC). CMS states, "The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only."

Scenario 2. To bill both components (the global service): When services are provided in an office setting, where the pulmonologist owns the equipment, 94010 (or 94060), which encompasses the TC and 26 portions, is reported. Be careful not to add a modifier. Why: The total RVUs for codes reported without a modifier include values for physician work, practice expense, and malpractice expense, CMS explains in the fee schedule attachment.