Pulmonology Coding Alert

Question: I read your article, “Get the Truth About These 3 Mind-Bending PFT Coding Myths,” in Pulmonology Coding Alert, Volume 23, Issue 3, and I have a follow-up question.

If a pulmonologist performs plethysmography alongside spirometry during an encounter, can we bill plethysmography separately?

Texas Subscriber

Answer: Yes, you can report plethysmography on the same date as spirometry.

You can actually bill two additional, more specialized tests separately from spirometry. According to CPT^® guidelines, 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) and 94727 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) “may be reported separately” from spirometry. These two codes do not include spirometry, which is coded to 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation), or bronchial provocation, which is coded to 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)).

“Codes 94726 and 94727 were added to CPT^® in 2012 to replace old codes that were duplicative in work. Each one describes a different method of determining lung volumes, and in the Guidelines [the American Medical Association] created that year, CPT^® clearly indicates that you would not bill both together,” says Melanie Witt, RN, MA, an independent coding consultant and AAPC Consulting Editor from Guadalupita, New Mexico.

Plethysmography and spirometry are inherently different tests. Spirometry helps physicians determine the amount of air the patient’s lungs can inhale and exhale quickly to gauge if the patient is suffering from an obstructive or restrictive lung disease. Plethysmography measures how much air remains in the lungs, so the physician can evaluate lung compliance — or if the lungs are stiff.