Pulmonology Coding Alert

Submit Bills Consistently to Avoid Denials

Higher reimbursement rates for 94014 may mean pulmonologists will use at-home monitoring more frequently than in the past.
 
Before the payment increase, most physicians didn't use 94014, says Charlie Strange, MD, associate professor of pulmonary medicine at the Medical University of South Carolina in Charleston. That's because the at-home codes paid about the same as a routine, monthly spirometric interpretation (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and yet required more work.
 
For example, if your pulmonologist decides to monitor a patient with at-home spirometric testing, the results will be transmitted daily through the Internet from the spirometer's computer to a remote terminal at a medical center or physician's office, where your physician analyzes the data. Such frequent testing lets both the pulmonologist and patient know how well the treatments are working and how well the patient forces air out of the lungs. By contrast, patients on routine spirometry have less severe symptoms, which allows for in-office testing once a month.
 
And even though you may report at-home spirometry codes once per month to your carrier, the interpretations occur on several dates. Physicians will now receive money for that additional work more than they would if you reported 94010 so the payment increases make sense, Strange says.
 
Medicare and other carriers, however, could continue to deny payment if you don't know how to bill correctly for the procedure, Pohlig says. Your pulmonologist should perform each component within a 30-day period to bill for 94014. If you miscalculate and submit a bill twice in the 30-day period, you will be hit with denials, she says.
 
You can also avoid denials by submitting bills for these codes at the same time each month. Reporting these services at scheduled intervals helps to prevent overlapping claims that could result in denials, Pohlig says. For example, avoid billing on the last day of one month and then following that with a bill in the middle of the next month.
 
You could run into problems with private carriers, regardless of how consistently and accurately you bill. For example, Aetna states that it does not cover home oxygen testing, citing inadequate evidence that such monitoring will improve patient care.
 
According to Strange, medical specialists rely on at-home spirometry for assisting with patient care. "We've recognized for many years that people who have a lung transplant can deteriorate pretty quickly," he says. Therefore, daily testing for these patients is crucial.
 
Still, most carriers simply want to ensure proper payment, Pohlig says. Because so many requirements have been placed on 94014, carriers want to make sure that physicians properly understand how to use the code, she says.
 
Editor's note: To read CMS memorandum AB-03-070, log on to http://cms.hhs.gov.