Pulmonology Coding Alert

Question: We received a superbill for a "complete PFT" with multiple codes marked. These procedures are all included in the report, in addition to spirometry. Is there a bundle code for a complete PFT, or do I list all codes and include modifiers?

Michigan Subscriber

Answer: There is no "comprehensive code" for reporting multiple PFTs. Your first step is to check all your CPT codes against the Correct Coding Initiative (CCI) bundling list to see if any are bundled together. Spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) is usually bundled with most other procedures, so also look out for that potential bundle.

You'll probably need modifier 26 (Professional component) on each procedure code unless the physician performs the service in his private office and owns the equipment. Pulmonologists order these tests in a pulmonary function lab, which, if the lab is privately owned by the pulmonologist or group, doesn't necessitate reporting modifier 26.

There is no standard definition for a "complete PFT." Physicians usually measure lung volumes, flows, and a diffusion capacity during a "complete" study, though your physician might also include some other tests. Codes that could apply to your case include:

• 94010 or 94060 -- Spirometry or spirometry with bronchodilation

• 94240 -- Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method

• 94260 -- Thoracic gas volume

• 93720 -- Plethysmography, total body; with interpretation and report

• 93722 -- ... interpretation and report only

• 94620 -- Pulmonology stress testing, simple

• 94360 -- Determination of resistance to airflow, oscillatory or plethysmographic methods

• 94720 -- Carbon monoxide diffusing capacity.

The specific codes you report depend on the test components performed. Certain carriers might have different guidelines regarding some of the measures, so learn what they are and follow them.

Break out notes: Modifier 59 (Distinct procedural service) may be appended to bundled services, but only when the physician performs the services for distinct and separate reasons, or during separate sessions on the same calendar date. Spirometry is bundled into most other PFTs and may not be eligible for unbundling. When appropriate and bundling edits allow, as in the exercise test example above, you may append modifier 59 to the bundled service.