Pulmonology Coding Alert

Question: Has anyone heard any definitive information regarding a respiratory therapist being the only one permitted to do pulmonary function tests (PFTs) even in an office setting, or can a physician or even a supervised medical technician (as long as there is a physician in the office) perform them? I had heard this was being discussed, but have seen nothing in writing yet. Also, I need some clarification on coding PFTs. When I assign 94060, 94240, 94720, or 94360, am I supposed to also use 93720? Or is this already included in one of the codes Im already reporting?

New Jersey Subscriber

Answer: Contrary to what you have heard, there is no directive stating that only respiratory therapists are permitted to administer PFTs. Staff who administer PFTs should be trained and knowledgeable about PFT testing. You may want to review the guidelines for PFT personnel that the American Thoracic Society published in 1986 (American Review of Respiratory Disease Vol. 134:623-624) and has not updated. To our knowledge, no other personnel guidelines have been written.

In your coding sequence, you indicate that the pulmonologist measured lung volumes by helium dilution or nitrogen washout (94240, Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method) and that airway resistance was measured separately, not with a body box (plethysmograph). Therefore, in this example, you would code the sequence as 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration), 94240, 93720, 94720 (Carbon monoxide diffusing capacity [e.g., single breath, steady state]).

If the pulmonary function laboratory measured lung volumes and airway resistance with a body plethysmograph, then you would code thoracic gas volume (94260) for the lung volumes and 93720 (Plethysmography, total body; with interpretation and report) for the plethysmography portion. Since payers bundle airway resistance with the plethysmography code, you cannot bill it separately.