Pulmonology Coding Alert

Question: A patient completes a six-minute walk test in our office, then the pulmonologist interprets the test and sees the patient for an office visit. Can I bill for both the test and the office visit on the same day? If so, do I need to add modifiers?

Nevada Subscriber

Answer: You can code both services on the same day, whether the six-minute walk test and E/M visit have the same diagnosis or different ones.

Report the six-minute walk test with 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]).

If the test is performed in the physician's private office and he owns the equipment, you will not need to add a modifier to 94620. If the test is performed in a facility-based office, however, you should append modifier 26 (Professional component), regardless of equipment ownership.

Choose the most appropriate code for the E/M service from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). You are not required to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) since these services are not bundled together. Some commercial carriers, however, might require modifier 25 when you report visits with any other service.