Pulmonology Coding Alert

Medicare has recently accepted recommendations to split HCPCS code 94620 (pulmonary stress testing, simple and complex) into two new codes:

94620Pulmonary stress testing; simple (eg,prolonged exercise test for bronchospasm with pre- and post-spirometry); and

94621Pulmonary stress testing; complex (including measurements of CO2 production, O2 uptake, and electrocar- diographic recordings).

Charlie Strange, MD, FCCP, associate professor, Department of Pulmonary Medicine, Medical University of South Carolina, Charleston, S.C., welcomes the new code for complex pulmonary stress testing as a significant improvementalmost double the value of the previously combined procedure. In the past, pulmonologists had only the one code (94620 before January 2000 included both simple and complex testing), which did not adequately cover the level of services and equipment used in complex testing, he says.

Pulmonary stress testing is performed on patients who complain of shortness of breath. The test allows the physician to determine if the underlying cause is heart disease or lung disease. Heart disease patients are sent off to the cardiologist, lung disease to the pulmonologist, Strange explains.

One of the key differences between the new simple pulmonary stress test and complex codes is the inclusion of expired gas analysis in the complex code. Strange says that expired gas analysis cannot be performed on patients who are on oxygen since the collector used in the integrated exercise system would also catch the supplemental oxygen. He says patients using supplemental oxygen would be given the simple test.

Access to the exercise testing equipment may also make a difference in which test is used. Strange says most medium-to-large metropolitan areas have hospitals or university clinics with the expensive equipment used in the complex pulmonary stress test. The value of the code is meant to cover physician services, not the equipment costs. The complex pulmonary testing code is designed to cover instances where the physician supervises the patient during the duration of the testing, then interprets the results, including measurements of carbon dioxide production, oxygen uptake and EKG recordings.

Pulmonologists who do not have access to the specialized equipment are likely to perform the simple test, supervising the patient and interpreting the results without analysis of the additional measurements. In the past, pulse oximetry was billed in addition to this pulmonary stress testing.