Pulmonology Coding Alert

Question: A pediatrician referred an 18-month-old patient to our pulmonology practice for a PFT. The documentation indicates the patient has been experiencing breathing difficulties, and the pediatrician wants the pulmonologist to check the child’s breathing performance. The documentation says the pulmonologist performed a measurement of spirometric forced expiratory flows with and without bronchodilation.

Can you please explain which CPT^® code(s) I need for my report?

Louisiana Subscriber

Answer: Two CPT^® codes exist for the measure of spirometric forced expiratory flows in infants or children up to 2 years old. Based on the information in your question, you’ll select 94012 (Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age), as the documentation includes the use of a bronchodilator. During the procedure, the provider performs a pulmonary function test (PFT) to safely, yet forcibly, exhale all the air from the child’s lungs. A physician uses the test to assess the forced expiratory airflow to check for lung issues and disease, judge airway function, and determine if different therapies are effective. After the procedure, the patient’s provider evaluates the data and records the results.

If the pulmonologist performed the test without bronchodilation, then you’d choose 94011 (Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age).

Note: Do not report both 94011 and 94012 on the same date. National Correct Coding Initiative (NCCI) edits only allow one of these codes to be reported on a given date.