Pulmonology Coding Alert

You Be the Coder:

Should You Challenge Peak Flow Denial?

Question: An insurance company told me that the code we are using for peak flow (94250) is incorrect. What code should I use?

Ohio Subscriber

Answer: CPT considers peak flow rate an inherent part of the E/M service and does not provide a distinct code for the diagnostic test. A HCPCS Level II code does exist for this service (S8110, Peak expiratory flow rate [physician services]). But insurers may follow Medicare's lead and consider S8110 incidental to pulmonary function testing and E/M services, as Empire State Medicare Services does.
 
Better practice: When a pulmonologist uses the handheld peak flow meter, you should instead include the diagnostic test in the E/M service. Count the measurement as part of "the amount and/or complexity of data to be reviewed" medical decision-making element.
 
Coders sometimes mistakenly report peak flow rate with 94150 (Vital capacity, total [separate procedure]), but 94150 describes computerized spirometry, not peak flow measurement.
 
You should also not report peak flow rate with 94250 (Expired gas collection, quantitative, single procedure [separate procedure]). Pulmonary function technologists frequently perform this test as part of a pulmonary stress test (94620, Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry] and 94621, ... complex [including measurements of CO2 production, O2 uptake, and electrocardiographic recordings]), and thus it is incidental to 94620-94621.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Pulmonology Coding Alert

View All