Pulmonology Coding Alert

Question: We performed pulmonary function tests (PFTs) on an outpatient basis at the hospital, and we billed for PFTs and spirometry procedures with modifier 26. What is the difference between these two codes?

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Answer: There is no CPT^® code for pulmonary function tests. You should code for the specific tests the pulmonologist administered to the patient. When the physician interprets the tests from a pulmonary function lab not owned by the practice, you should report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) with modifier 26 (Professional component) for simple spirometry.

If the physician measures simple spirometry before and after bronchodilation, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with modifier 26 for the professional component, which includes all of the work of 94010 but gives a better analysis of the problem and the effects of treatment.