Pulmonology Coding Alert

Question: I've heard that a pulmonary function test (PFT) needs to have a physician interpretation before some payers reimburse it. Is this correct?

Hawaii Subscriber

Answer: Your pulmonologist's interpretation doesn't have to be complete at the time of your billing, just as long as you're reporting your services using modifier TC (Technical component). Refer to the Joint Commission on Accreditation of Healthcare Organizations' guidelines, which require that physician interpretation be done in a timely manner. Generally, hospitals interpret this to mean that the physician interpretation should be done within 48 to 72 hours.

Hidden trap: Use modifier TC to tell the carrier that your hospital is billing for the equipment, room charge, and technician, but not for the pulmonologist's interpretation.If the pulmonologist who renders the interpretation is with a separate professional group and is not a hospital employee, the pulmonologist should report the service separately with modifier 26 (Professional component).

Tip: Filing for a PFT claim without a modifier indicates that your practice performed both the professional and technical components.