Pulmonology Coding Alert

Question: What is the appropriate E/M code for a pulmonary consultation with pre- and post-bronchodilator spirometry when a military academy (instead of a physician) has requested it? The pulmonologist in my practice saw a 17-year-old patient applying for the academy; the patient has a history of acute bronchitis, but had no current respiratory-related concerns. The exam turned out normal while the pre-and post-bronchodilator spirometry was normal with no obstruction and no bronchodilator responsiveness.

Nebraska Subscriber

Answer: You should bill new patient visit code 99201-99205 provided the patient is not established to the practice (seen by a physician in the practice within the last three years). This would not constitute a consultation service since only healthcare providers involved in the patient's care can request a consultation. School personnel cannot request a consultation as an entrance requirement.

Additionally, the service is typically paid for by the patient himself or the military academy, depending on the agreement. It is not billed to insurance since these types of services are typically noncovered by medical insurance, unless the patient is receiving medical guidance/direction for an existing condition (e.g., asthma).

Don't overlook: When billing for pre- and postspirometry tests, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration). However, the insurance carrier may or may not pay for the pulmonary function test due to the screening nature of test's request (the request coming from a military academy). It is likely that the patient may end up paying for the charges.