Pulmonology Coding Alert

Question: Can you help delineate the difference among the different types of pulmonary function testing codes?

Massachusetts Subscriber

Answer: Pulmonary function tests (PFTs) can measure the patient's lung volumes, airflow, compliance, gas transfer, and other physiologic parameters. If the pulmonologist performs simple spirometry  which graphs the vital capacity and expiratory flow  or if the flow volume loop (FVL) is not complete  use 94010 (Spirometry, including graphic records, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation).

If an FVL is measured without bronchodilator administration, use 94375 (Respiratory flow volume loop). If the physician performs spirometry pre- and postbronchodilator administration, use 94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and postbronchodilator administration).

Pay attention to certain codes that the Correct Coding Initiative (CCI) has bundled together. For instance:

• 94010 is bundled with 94375, and

• 94010 and 94375 are bundled with 94060.

The technical components of the above codes require general supervision of a physician, except 94060, which requires direct supervision. This means 94060 requires the presence of a physician in the office suite who is immediately available to furnish assistance and direction throughout the procedure.

When reporting hospital-based services, split-bill the professional fee and the technical component using modifier 26 (Professional component) and TC (Technical component), correspondingly. The physician should report the pulmonary function code with modifier 26 and the hospital would report the identical code with modifier TC. Lastly, ensure that the required documentation appears in the patient's chart, including the treating physician's order, the diagnostic indications to support medical necessity, and the physician interpretation of results.