Pulmonology Coding Alert

Question: After a level-three new patient E/M, the pulmonologist orders a methacholine challenge test in the office. The patient also undergoes plethysmography to measure airway resistance. The methacholine challenge included 50 mg of methacholine chloride. Can I code the plethysmography separately in this encounter?

Minnesota Subscriber

Answer: The plethysmography, when performed as part of a methacholine challenge test, is separately codeable. On the claim, report the following:

• 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) for the challenge test

• 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]) for the challenge test measurement

• 94360 (Determination of resistance to airflow, oscillatory or plethysmographic methods) for the plethysmography

• J7674 x 50 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg) for the testing supply.

• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; medical decision-making of low complexity) for the E/M

• modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99203 to show that the E/M, airway resistance measurements, and methacholine challenge were separate services. (Note: Some payers might not require modifier 25 for this scenario. If you are unsure of the payer's policy, check it before filing the claim.)