Pulmonology Coding Alert

Let your patients do the walking and 94620 or 94761 do the talking

Pulmonologists often order simple or complex stress tests or use pulse oximetry to measure similar metabolic functions, but coders don't always know which stress-test code to report. 

During a stress test, the pulmonologist measures the patient's lung function according to the degree of reduced oxygen in the blood or desaturation in the lungs as dyspnea occurs after the patient walks on a treadmill or pedals on a stationary bicycle.  Alternatively, the pulmonologist may measure the distance the patient walks, dyspnea, oxyhemoglobin desaturation and heart rate during one session. The pulmonologist would use a six-minute walk test to record this information.

Case example: A patient presents with shortness of breath (786.09, Dyspnea and respiratory abnormalities; other) and a cough (786.2, Cough). Before the test, the pulmonologist records a baseline spirometry for the patient. Then the patient walks on the treadmill, and the pulmonologist records a subsequent spirometry to check for bronchospasm, says Roger Hettinger, CPC, CMC, CCS-P, coding specialist with Sioux Valley Clinic in Sioux Falls, S.D.

The Choice Is Simple ... or Complex? For the scenario above, you peruse your CPT book and narrow the choice down to 94620 (Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and postspirometry]) or 94621 (... complex [including measurements of CO2 production, O2 uptake, and electrocardiographic recordings]).

The difference: If the pulmonologist checked for exercise-induced bronchospasm and recorded pre- and postspirometry, you should report 94620 for a simple test, says Susan Rittel, RHIT, CCS-P, CPC, healthcare consultant in Fargo, N.D.  

Remember: Pulmonologists may order simple pulmonary stress tests, such as six-minute walk tests, on patients who fall into one of the following categories, Rittel says:  

those with the physical conditions of unexplained shortness of breath  

those undergoing disability evaluation to determine the severity of a disease such as asbestos  

those undergoing evaluation to determine if they meet Medicare's requirement for supplemental oxygen.

Don't miss: Refer to "2 Questions You Need to Ask Before You Report Stress Tests and Bronchodilation" in this issue to understand how spirometry may make or break 94620 coding. 94621 Tells a Larger Story When the pulmonologist performs a complex stress test, he integrates both cardiac and pulmonary functions with the status of the patient's physical fitness.

To perform a complex stress test, the pulmonologist records the patient's carbon dioxide production, oxygen uptake and electrocardiographic recordings, in addition to the patient's peak cardiovascular and ventilatory responses while under physical exertion.

Based on the results of the test, the pulmonologist looks at the patient's dyspnea index, an anaerobic threshold, as a percentage of maximum oxygen uptake and consumption as it relates to cardiac uptake.

Hint: Complex tests [...]