Pulmonology Coding Alert

Question: Who should have pulmonary stress testing? What are the requisites to conduct this test in the office? I know I have to use 94620 when billing for pulmonary stress testing, but I'd like to know the specifics.

Georgia Subscriber

Answer: Performing pulmonary stress testing (PST) in the office most commonly takes place as the 6-Minute Walk" having the patient walk in the hallway (of approximately 100 feet in length) for six minutes, and measuring her breathing rate. During the test, when the physician notices a certain level of shortness of breath, she may prescribe oxygen or other medications for the patient. The physician may also ask the patient to come back for another test, if only to ensure that the therapy is working properly.

Patients with COPD (496, Chronic airway obstruction, not elsewhere classified) or other chronic pulmonary and cardiac disorders are usually the subjects of PST. When you bill for PST, you will use 94620 (Pulmonary stress testing; simple [e.g., 6-minute walk test, prolonged exercise test for bronchospasm with pre- and postspirometry and oximetry]) which can get you about $64 in revenue for a single test (1.87 RVU multiplied by the 2011 conversion factor of 33.9764). Your diagnosis code, on the other hand, should suggest some type of chronic breathing condition, or an acute condition that involves careful  monitoring (e.g., 491.x, Chronic bronchitis).

Advice: Be careful about documenting PST. Make sure you record the patient's weight, height, age, oxygen saturation, blood pressure, and shortness of breath levels. Additionally, indicating monitoring activities and other pertinent information will help to support medical necessity for the test.

Tip: Some insurance companies will be willing to provide you with sample forms that you can modify for use in your office. It won't hurt if you ask the insurance company of their requirements for billing PST.