Ace your Pulmonary Function Testing Claims

Read answers to these two expert medical billing and coding questions and know the accurate CPT codes for pulmonary function testing.

Question: Your practice is interested in carrying out pulmonary function testing on asthma patients. How would you bill? 94010? 94016? Can you also charge a copayment? Is it worth buying a spirometry device?

Answer: CPT code for pulmonary function testing is essentially 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). A lot of many physicians consider they can bill 94010 for a hand held peak-flow meter, which has no code and is not distinctly billable.

You should not code 94016 (patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only) lest the patient had a spirometer at home. The key to coding 94016 is carrying out the interpretation, whether you get reports over the phone lines from a rented machine in the patients home, or the patient brings printouts in.

The other CPT code for pulmonary function testing is 94060 (bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). You should not use 94060 and 94010 on the same day. The bronchodilation is included in the 94060; do not bill for it distinctly.

Both 94060 and 94010 need a spirometer with a mechanism that shows results graphically. Whether it is worth buying one depends on the total asthma patients you have. A lot of pediatricians treat asthma without a spirometer; however, pediatricians who specialize in asthma and allergy could not get by without one. Primary care pediatricians should know that its not at all times easy to get good spirometry on younger children

Question: You have the CPT codes for the pulmonary function test (PFT) interpretations. However you are required to know if for a whole PFT study there is one code to bill with the modifier -26 (professional component), or should you bill for each procedure? For instance, in case a patient has complete PFTs (e.g., carbon monoxide diffusion capacity, and spirometry with bronchodilation, plethysmographic method), is there a particular code for the complete reading?

Answer: CPT code 94060 (bronchospasm evaluation; spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) includes the following codes:

· 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)

· 94200 (maximum breathing capacity, maximal voluntary ventilation)

· 94375 (respiratory flow volume loop)

· 94640 (nonpressurized inhalation treatment for acute airway obstruction)

· 94650 (intermittent positive pressure breathing IPPB) treatment, air or oxygen, with or without nebulized medication; initial demonstration and/or evaluation)

· 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation)

· 94770 (carbon dioxide, expired gas determination by infrared analyzer )

Bill all other CPT codes for the pulmonary function test distinctly. Append modifier -26 if services are carried out in a hospital and your physician is giving a written interpretation and report.