Pulmonology Coding Alert

Question: During an initial consultation with a new patient complaining of wheezing and breathlessness, the pulmonologist suspects emphysema. After a level-four consult, the technologist performs spirometry with graphic record, lung volumes by gas dilution, and diffusing capacity for carbon monoxide (DLCO). How should I report this scenario?

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Answer: The CPT codes will be the same regardless of the tests’ outcomes. Your diagnosis coding will depend on whether the pulmonologist confirms a diagnosis
of emphysema.

Option 1 -- Definitive diagnosis. The physician confirms a diagnosis of emphysema. On the claim, you would report the following:

• 94010 (Spirometry, including graphic record, total and timed vital capacity; expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for the spirometry.
• 94240 (Functional residual capacity or residual volume: helium method, nitrogen open circuit method, or other method) for the lung volume.
• 94720 (Carbon monoxide diffusing capacity [e.g., single breath, steady state]) for the diffusing capacity.
• 99244 (Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity) for the E/M service.
• 492.x (Emphysema) linked to 94010, 94240, 94720 and 99244 to prove medical necessity for the encounter.

Option 2 -- Inconclusive diagnosis. After the tests, the results are inconclusive or negative for emphysema. Consequently, you should rely on the signs and symptoms to support medical necessity for your physician’s services.

On the claim, you would list the following:

• 94010 for the spirometry.
• 94240 for the lung volumes.
• 94720 for the diffusing capacity.
• 99244 for the E/M service.
• 786.05 (Shortness of breath) and 786.07 (Wheezing) linked to 94010, 94240, 94720 and 99244 to prove medical necessity for the encounter.