Pulmonology Coding Alert

You Be the Coder:

Fight Denials On Office Visits With PFTs

Question: Recently, several insurance plans denied coverage for an office visit when reported with spirometry. In the first case, we reported 99215-25 for the office visit and 94060 for bronchospasm evaluation on the same day. In another case, the pulmonologist performed the bronchospasm evaluation (94060) two weeks prior to the office visit (99215). In both cases, the carriers denied coverage for the office visit and paid only for the bronchospasm evaluation. Am I failing to add a correct modifier or do you know of any documentation that can aid in the appeal? California Subscriber Answer: In both scenarios, the insurance company should pay for both the E/M-25 service (99215, Office or other outpatient visit for the evaluation and management of an established patient ....] [Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or  other service]) and the pulmonary function tests [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Pulmonology Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.