Pulmonology Coding Alert

Question: For a patient who undergoes 6 min walks under pulmonary stress testing, should we bill globally under 94620 or separate the technical component and the interpretations? We performed these services in a private office.

California Subscriber

Answer: When a procedure or service involves a technical component as well as the professional component, these come under the definition of a global service. More specifically, diagnostic testing, such as pulmonary stress testing, involves a technical component (modifier TC) to account for the administration of the test, data recording, and/or data transmissions. It also involves a professional component (modifier 26) that represents the physician review and test interpretation.

Reporting a global code or a component code depends upon the service location. If the physician practices in a private office setting (i.e., place of service 11), report the global code since the physician owns or directly leases the equipment. If the physician practices in a facility-based setting (e.g., place of service 22 or 23), report only the professional component regardless of equipment ownership. The facility must report the technical component.

If split billing is claimed, the reimbursement under technical component will be provided to the hospital that is providing the space and equipment for the services, while the professional component will reimburse the services provided by the interpreting physician. Although the payouts for split billing with a technical component and a professional component can be higher, not every service can be claimed under a split billing.

Appropriate modifiers should be placed with the claim. TC should be inserted for the technical component and modifier 26 (Professional component) should be claimed for the professional component.

In your case, the billing can be global with the code being 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry]). For facility-based reporting, you would report only 94620-26. The facility submits the claim for 94620-TC.