Pulmonology Coding Alert

Question: I noticed that CPT 2010 includes new spirometry codes. We're a general pulmonary practice. Should I add those codes to my superbill?

Florida Subscriber

Answer: No, codes 94011-94013 are for infant pulmonary function testing (PFT). "There are only about 30 pediatric pulmonologists who could do that testing until technology changes," said Scott Manaker, MD, PhD, who is the American College of Chest Physicians (AACP/ATS) representative to the Relative Value Update Committee (RUC) in the "Pulmonary Medicine" session at the AMA CPT and RBRVS Annual Symposium in Chicago. "A pediatric pulmonologist usually performs the test, but a general pediatrician or another pediatric pulmonologist often orders the test."

The tests are done only in children up to age 2. Before this age, the patient can't cooperate with standard spirometry, so pediatric pulmonologists needed specific codes for these tests, Manaker explained.

The first two codes in the set (94011, Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age; and 94012, Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age) are for expiratory flow measurements with 94012 utilizing a bronchodilator between measurements.

The third code (94013, Measurement of lung volumes [i.e., functional residual capacity [FRC] forced vital capacity [FVC], and expiratory reserve volume [ERV]] in an infant or child through 2 years of age) is for lung volume measurements.

These codes are not your typical spirometry as in 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). During an infant PFT test, 94011, the child's chest is squeezed.

Under sedation, the patient is placed in a rapid inflate jacket, which makes the child forcibly exhale all the air allowing the generation of flow volume curves. In 94012, the pulmonologist determines if airflow limitation will improve after bronchodilator use.

These tests are always done in a facility. You need a number of people to perform the tests, including a nurse anesthetist for monitoring the sedation, a respiratory therapist, and a pediatric pulmonologist. A critical care team should be available in case of a cardiopulmonary arrest.