Pulmonology Coding Alert

Question: An elder patient who walked several blocks to our practice presented with dyspnea and cough. The pulmonologist sent her for spirometry, and the result came back normal. While on the treadmill for the simple pulmonary stress test (PST), the patient experienced dyspnea, so the pulmonologist ordered a repeat spirogram to document the patient's exercise-induced bronchospasm. What codes should I use to report this scenario?

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Answer: Although the initial spirometry came out normal, the patient's history was obviously consistent with exercise-induced bronchospasm. It means PST is medically necessary. You should use 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]) to report PST, and report the initial spirometry as a separate service by appending modifier 59 (94010-59).

For your diagnosis codes, you should link 786.09 (Dyspnea and respiratory abnormalities; other) to the initial spirometry code 94010, and 493.81 (Exercise-induced bronchospasm) to 94620.

Tip: Prove medical necessity of the simple pulmonary exercise stress test by enclosing a copy of the patient's records to your claim.

-- Clinical and coding expertise for this issue are provided by Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.