Pulmonology Coding Alert

Question: Our pulmonologist performs a fluoroscopic "sniff" test for evaluation of the diaphragmatic motion. We bill procedure 76000 for the reports, but most insurance companies will not pay this. How should I code this for optimal reimbursement?

Florida Subscriber

Answer: The correct code that represents the sniff test is 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), since the physician is not likely to meet the requirements of the codes for CXR with fluoroscopy (71023, 71034).

Caution: The problem with reimbursement is variable. Ensure that the diagnosis is accurate and reflective of the patient's condition. If the diagnosis is adequate, it could be a capitation issue.  Since fluoroscopy is considered a radiologic service, the patient's insurance may require that such services are obtained from specific entities (e.g., diagnostic testing centers) rather than the physician's office. In this case, the payer will not reimburse the pulmonologist directly for services that are contracted elsewhere.

Finally, the issue may be one of provider enrollment with the payer. Even though some services are acceptable for provision in the physician office setting, some payers require the physician to then dually enroll with the payer (e.g., pulmonologist and radiologist) before they allow reimbursement for radiologic services.