Pulmonology Coding Alert

Question: In your October 2005 issue, the answer to a reader question has me confused because it states that pre- or post-spirometries are not part of the "six-minute walk" test. CPT, however, clearly describes spirometry in the 94620 code descriptor. I've never found a definitive answer to the question of what exactly constitutes the "simple pulmonary stress test." Can you offer any insight?


Virginia Subscriber

Answer: The reason for all the confusion is the CPT descriptor for 94620 (Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry]), which describes an exercise-induced bronchospasm test rather than a six-minute walk test.
 
There are several simple pulmonary stress tests that you should report using 94620. These include the six-minute walk test and the exercise-induced bronchospasm test. The descriptor for 94620 includes the latter test but fails to mention the six-minute walk test. Coding experts say that CPT plans to add the six-minute walk test to the descriptor in 2007 to help clear up coding confusion.

During an exercise-induced bronchospasm test, the pulmonary function technologist measures spirometry before and after vigorous exercise. The patient exercises on a bicycle or treadmill that induces bronchospasm. This test is totally different than the six-minute walk test that requires the patient to walk as fast as he can for six minutes. During the six minutes, the pulmonary function technologist monitors the patient's oxygen saturation, heart rate and dyspnea.

The six-minute walk test does not involve spirometry. You should report the test as a simple pulmonary stress test using 94620. The July 2005 CPT Assistant clarifies that you should use 94620 for this test. The walking exercise in the six-minute walk test is not sufficient to induce bronchospasm since its purpose is to evaluate the exercise ability of patients with moderate to advanced lung diseases.

Tip: As noted in the October 2005 issue of Pulmonology Coding Alert, if your pulmonologist also orders spirometry or spirometry before and/or after the six-minute walk test, you may be able to report it separately from the pulmonary stress test. Many pulmonologists and professional organizations agree that it is separately reportable since this is not a routine part of the six-minute walk test.

In other words, the physician orders spirometry for a separate reason. If this occurs, add modifier 59 (Distinct procedural service) to 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) or 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) to indicate that the test is a separate test from 94620 and to override the National Correct Coding Initiative edit that includes 94620 with 94010 or 94060.