Wiki Spirometry followed by Methacholine bronchoprovocation study--both billable?

[FLSJarrel]

We are having a discusion in our office about whether both a spirometry (94010) & a methacholine bronchoprovocation challenge study (94070) can both be billed when performed on the same day. The Spirometry was performed at 12:10, while the challenge was performed at 13:15. Only one Hospital report with the test results was generated including the numbers for both procedures. Our MD then interpreted the results generating two reports as follows:

Spirometry:

PULMONARY FUNCTION TEST
Spirometry shows normal FEV1 to FVC ratio of 86%. FEV1 is normal at 3.26, 114%. FVC is also normal at 3.76, 106%.
IMPRESSION: Normal spirometry.

Challenge:
PULMONARY FUNCTION TEST
This is a methacholine bronchoprovocation challenge study to evaluate for inducible reactive airways obstruction.

The patient is a Caucasian female who is 64 inches tall and weighs 222 pounds. Prior to methacholine challenge study, the patient had a normal spirometry. The patient underwent incremental increases of inhaled methacholine from zero with normal saline to a high dose of 10 mg/mL inhaled methacholine. The patient did not demonstrate any inducible airway obstruction. The FEV1, however, had an inducible small airways reaction at the highest dose at minus 44%. This reducible airway obstruction was resolved with stop of study and a dose of bronchodilator.

IMPRESSION: Small airways inducible obstruction, manifested as decreased function in FEF25-75%. This is consistent with very, very mild asthma at this level. This obstruction was resolved with therapy with short-acting bronchodilators.


Are both of these billable? Or is the spirometry reading included in the challege?
Any help in determining the answer would be greatly appreciated. Thanks.

 

[jackson7591]

clarifications?

What was the purpose of the initial spirometry? Was it to establish a baseline prior to the challenge study?

Is there documentation that the challenge study was necessary above and beyond the results of the intial sprirometry testing?

 

[FLSJarrel]

The Challenge was ordered, then they did the spirometry followed by the challenge. So I believe it was a baseline for the challenge. The spirometry was not the reason they did the challenge. And other than the reports posted there is no other indication than the diagnosis of Pulmonary nodules/wheezing that was given for the reason for the test.

 

[jackson7591]

My thoughts are that some documentation would be necessary both to explain the medical necessity of the spirometery prior to the challenge study (baseline?) and the the rationale for performing the challenge study as well. And without additional diagnoses/symptoms/complications, concerns etc.., would be difficult to show the medical necessity of a challenge study following a normal spirometry.

Have been pointedly reminding our providers to document the necessity of specific tests. In many instances there is a reason, it just isn't in the chart. And that's a problem


Anyone else?