Pulmonology Coding Alert

Question: The pulmonologist visits with a new patient complaining of wheezing and shortness of breath. After a level-four E/M service, the pulmonologist orders a six-minute walk test and interprets the results. The practice owns the walk test equipment. Can I report the test separately, or should I roll it into the E/M level?

Minnesota Subscriber

Answer: If the pulmonologist performs the E/M that results in the order for the six-minute walk test, then provides the interpretation and report, you can report the six-minute walk test separately.

On the claim, report the following:

• 94620 (Pulmonary stress testing; simple [e.g., six-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]) for the walk test.

• 99204 (Office or other outpatient visit for the E/M of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity) for the E/M.

• 786.07 (Wheezing) linked to 94620 and 99204 to represent the patient's wheezing

• 786.05 (Shortness of breath) linked to 94620 and 99204 to represent the patient's breathlessness.

Problem: If the pulmonologist does not interpret and report the six-minute walk test, you cannot report 94620.

Solution: When the physician performs an E/M and then performs a walk test with no interpretation and report, roll that test into the overall E/M level and report the appropriate-level code.

-- Answers to You Be the Coder and Reader Questions were answered/ reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.