Pulmonology Coding Alert

Question: We just saw a patient with cystic fibrosis (CF) and the physician performed a panel of tests to monitor his lung function. Is there a CF panel we can report for these tests?

Codify Subscriber

Answer: You won’t find a single panel to report the tests used to evaluate CF, but you can bill the tests individually.

Pulmonary physicians often use spirometry to monitor the lung function of their CF patients. You should use 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) to indicate repeat spirometry performed to evaluate a patient’s response to newly established treatments, to monitor the course of CF, or to evaluate a patient continuing with symptoms after initiating treatment. If the pulmonologist performs the spirometry both before and after administering bronchodilators, you should report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration), which includes all of the work of 94010 plus more, and gives a better analysis of the problem and the effects of treatment.

You’ll also encounter a variety of additional codes, but many are considered bundled into 94060 by the National Correct Coding Initiative (NCCI) including 94200 (Maximum breathing capacity, maximal voluntary ventilation), 94375 (Respiratory flow volume loop), 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device), and 94770 (Carbon dioxide, expired gas determination by infrared analyzer). These component codes cannot be reported on the same date in addition to 94060.

Keep in mind that 94200, 94640, and 94770 have a modifier indicator of “1” in NCCI. Therefore, they could be reported separately if performed as a separate and distinct procedure and not part of the same testing. To show this, you should append a modifier such as 59 (Distinct procedural service) to the bundled code, but only when documentation supports this scenario.