Pulmonology Coding Alert

Question: We are having trouble coding for bronchospasm evaluations here at our office. Can we code for 94010 and 94070, along with the bronchospasm evaluation?

Georgia Subscriber

Answer: First, you need to be clear on the definition of a bronchospasm test and spirometry. Spirometry measures lung volume and function and is used to diagnose chronic obstructive pulmonary disease (COPD) or check asthmatic patients. The code for spirometry alone is 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). The bronchospasm test uses a bronchodilator, along with spirometry, to diagnose the presence of reactive airways. Spirometry is performed before and after the doctor administers a bronchodilator to dilate the airways.

For example, a 55-year-old patient presents with shortness of breath. After an evaluation, the pulmonologist decides spirometry will help diagnose the problem, such as COPD. The readings are decreased, so the physician performs a bronchodilation and follows up with another spirometry test. Readings are greatly improved, so he makes a diagnosis of COPD. You would use 94060 (Bronchospam evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) because an albuterol inhaler was used. You cannot code separately for the spirometry (94010) or the bronchodilation (94664) because they are bundled into the bronchospasm test (94060) in the Correct Coding Initiative edits.

The only way you could bill separately for these services is by using modifier -59 (Distinct procedural service) under special circumstances, as when the tests were performed at different times during the day. Also, 94060 may not be billed at the same time as 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) because it is bundled into this more comprehensive service.