Pulmonology Coding Alert

Question: If Dr. A is present in the office while a patient has a test with bronchodilator, but Dr. B does the interpretation of the test, should I bill the test and interpretation separately as a professional and a technical portion instead of reporting the test and interpretation under one code?

California Subscriber

Answer: Studies such as pulmonary function tests (PFTs) include a professional and technical portion.
In any practice setting, the technical portion of the test must include supervision from a physician. Most pulmonary tests require general supervision (physician available by phone or beeper) or direct supervision (physician available in the office suite).

Bronchodilation (94060, Bronchospasm evaluation: spirometry, as in 94010, before and after bronchodilator [aerosol or parenteral]) requires direct supervision, which means the physician must be present in the office suite during the test but does not have to be present in the room with the patient. 

Your private practice can report both the technical and professional portion by submitting a claim for the "global" code (e.g., 94060) as long as you've met all of your carrier's guidelines.

You should report the professional portion (e.g., 94060-26), and the facility reports the technical portion (e.g., 94060-TC) if the patient undergoes the PFT in a hospital setting.

If you are in a hospital setting, you should report the technical portion by identifying the supervising physician's name on the claim, even if the supervising physician is also the interpreting physician.

In independent diagnostic testing facilities, the facility reports the global code under the IDTF provider number, assuming that the facility meets all of the payer guidelines required for IDTFs.