Pulmonology Coding Alert

Question: The pulmonologist sees an established patient who is complaining of breathing trouble at the local hospital. The pulmonologist performs a complete spirometry and a respiratory flow volume loop. Can we report the spirometry and the loop separately?

Texas Subscriber

Answer: The Correct Coding Initiative (CCI) bundles the flow volume loop into the spirometry in this scenario. Medicare won't pay separately for the loop, though some private payers might. (Check your private carrier contracts for more information.)

Coding: In all likelihood, you won't be able to report the loop separately. When the insurer bundles the flow volume loop into the spirometry, report the following:

• 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measure-ment[s], with or without maximal voluntary ventilation) for the spirometry

• modifier 26 (Professional component) linked to 94010 to show that you are only billing for the professional portion of the code when provided in a facility setting

• 786.05 (Shortness of breath) linked to 94010 to represent the patient's breathing trouble.

Exception: If the payer will accept separate codes for the spirometry and the flow volume loop, then report the following:

• 94010 for the spirometry

• 94375 (Respiratory flow volume loop) for the loop

• modifier 26 linked to 94010 and 94375 to show that you are billing for only the professional portions of the codes

• 786.05 linked to 94010 to represent the patient's breathing trouble.