Pulmonology Coding Alert

Question:

Wisconsin Subscriber

Answer:

Pulmonary function test (PFT) claims without interpretation is acceptable for Medicare -- as long as you're billing services with modifier TC (Technical component). However, be sure to accomplish physician interpretation (by a member of your group, or via arrangement with another physician group) within a reasonable amount of time (i.e., 48 to 72 hours) to ensure that clinical and quality of care guidelines are met.

Tip: Don't forget that when component coding occurs for PFTs, the location of the testing plays a part in how you code these tests.

Example: A technologist in an outpatient hospital PFT lab performs respiratory flow volume test (94375, Respiratory flow volume loop). The lab should report 94375 appended by modifier TC to describe the technical component of the service. On the other hand, the physician who will provide the interpretation of the test should be sure to report the same code (94375) appended by modifier 26 (Professional component). The place of service for the interpretation should match the location in which the testing occurred (outpatient hospital), even if the physician typically practices in a private setting (such as the physician's office) since the interpretation was provided for a test that was performed in a facility setting.