Understanding Pulmonary Coding Guidelines

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Understanding Pulmonary Coding
Guidelines
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Understanding Pulmonary Coding Guidelines
Pulmonary function tests play a crucial role in
assessing respiratory health and diagnosing
pulmonary conditions. When it comes to coding
these tests, the Current Procedural Terminology
(CPT) provides comprehensive and component codes
to accommodate the variations found in pulmonary
function laboratories. In this article, we will
explore the pulmonary coding guidelines to ensure
accurate reporting and appropriate
reimbursement. Understanding Pulmonary Coding
Guidelines 1. Reporting Alternative Methods of
Data Calculation During a spirometry or other
pulmonary function session, it is important to
note that alternate methods of reporting data
should not be reported separately. For example,
the flow volume loop, which is an alternative
method of calculating a standard spirometric
parameter, is included in the standard spirometry
studies (rest and exercise) with CPT code
94375. 2. Reporting EM Services Physicians
attending pulmonary diagnostic testing or therapy
sessions should not report a separate Evaluation
and Management (EM) service if they only perform
a limited history and physical examination
related to the testing or therapy. However, if a
significant and separately identifiable EM
service unrelated to the testing or therapy is
provided, it may be reported with modifier 25.
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Understanding Pulmonary Coding Guidelines
3. Reporting Multiple Spirometric
Determinations When multiple spirometric
determinations are required to complete a service
described by a specific CPT code, only one unit
of service should be reported. For instance, CPT
code 94070 describes bronchospasm provocation
with an administered agent and utilizes multiple
spirometric determinations, similar to CPT code
94010. In such cases, a single unit of service
includes all the necessary spirometric
determinations. 4. Comprehensive Cardiopulmonary
Exercise Testing Comprehensive cardiopulmonary
exercise testing with CPT code 94621 involves
various component tests defined in the CPT
Manual. It is important to note that reporting
component services such as venous access, ECG
monitoring, spirometric parameters performed
before, during, and after exercise, oximetry, O2
consumption, CO2 production, and rebreathing
cardiac output calculations during the same
patient encounter as a cardiopulmonary exercise
test is inappropriate. Furthermore, reporting a
cardiac stress test or a pulmonary stress test
(CPT code 94618) or any components of these
stress tests during the same patient encounter as
a cardiopulmonary exercise test is also not
allowed. 5. Ventilation Management and EM
Services Under the NCCI (National Correct Coding
Initiative) program, ventilation management CPT
codes (94002-94004 and 94660-94662) should not be
reported separately with EM CPT codes. If both
an EM code and a ventilation management code are
reported, only the EM code will be payable.
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Understanding Pulmonary Coding Guidelines
6. Continuous Inhalation Treatment with Aerosol
Medication CPT code 94644, which describes
continuous inhalation treatment with aerosol
medication for acute airway obstruction (first
hour), does not include physician work RVUs
(Relative Value Units). When this procedure is
performed in a facility, the physician does not
have any practice expenses related to the
procedure, as it utilizes facility staff and
supplies. Therefore, physicians shall not report
this code when ordering it in a facility.
Additionally, this code should not be reported
with certain other CPT codes unless the physician
supervises the performance of the procedure at a
separate patient encounter on the same date of
service outside the facility where the physician
has practice expenses related to the
procedure. 7. Bronchodilation Responsiveness and
Inhalation Treatment CPT code 94060, which covers
bronchodilation responsiveness with pre- and
post-bronchodilator administration, is a
diagnostic test used to assess patient symptoms
related to reversible airway obstruction. It is
essential to understand that this code does not
describe the treatment of acute airway
obstruction. Reporting CPT code 94640
(pressurized or non-pressurized inhalation
treatment for acute airway obstruction) for the
administration of the bronchodilator included in
CPT code 94060 is considered misuse. However, the
bronchodilator medication may be reported
separately. 8. Inhalation Treatment for Acute
Airway Obstruction CPT code 94640 describes the
treatment of acute airway obstruction with
inhaled medication or the use of inhalation
treatment to induce sputum for diagnostic
purposes.
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Understanding Pulmonary Coding Guidelines
It is important to note that CPT code 94640
should only be reported once during an episode of
care, regardless of the number of separate
inhalation treatments administered. Reporting
spirometry measurements separately before and/or
after the treatment(s) is not appropriate.
Additionally, reporting CPT code 94060 in
addition to CPT code 94640 is considered misuse.
The inhaled medication, however, may be reported
separately. An episode of care begins when a
patient arrives at a facility for treatment and
ends when the patient leaves the facility. If
the episode of care lasts more than one calendar
day, only one unit of service of CPT code 94640
may be reported for the entire episode of care.
If a patient receives inhalation treatment during
an episode of care and returns to the facility
for a second episode of care with inhalation
treatment on the same date of service, the
inhalation treatment during the second episode of
care may be reported with modifier 76 appended to
CPT code 94640. In cases where inhalation drugs
are administered in a continuous treatment or a
series of back-to-back continuous treatments
exceeding one hour, CPT codes 94644 and 94645 may
be reported instead of CPT code 94640. 9.
Inhalation Treatment and Demonstration/Evaluation
CPT code 94640 and CPT code 94664 (demonstration
and/or evaluation of patient utilization of an
aerosol generator) generally should not be
reported for the same patient encounter. The
demonstration and/or evaluation described by CPT
code 94664 is included in CPT code 94640 if the
same device, such as an aerosol generator, is
used in both procedures. However, if these
services are performed at separate patient
encounters on the same date of service, they may
be reported separately.
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Understanding Pulmonary Coding Guidelines
10. espiratory Testing in Ventilation Management
and Critical Care Practitioner ventilation
management (CPT codes 94002-94005, 94660, 94662)
and critical care (CPT codes 99291, 99292,
99466-99486) encompass respiratory flow volume
loop (CPT code 94375), breathing response to
carbon dioxide (CPT code 94400), and breathing
response to hypoxia (CPT code 94450) testing if
performed. It is important to note that CPT code
94400 was deleted on January 1,
2021. Understanding the pulmonary coding
guidelines is crucial to ensure accurate
reporting and appropriate reimbursement. By
adhering to these guidelines, healthcare
providers can streamline their coding practices
and improve the efficiency of pulmonary function
testing and therapy. About Medisys Data
Solutions (MDS) Medisys Data Solutions (MDS) is a
renowned and leading pulmonary billing company
specializing in providing comprehensive billing
solutions for pulmonary services. MDS ensures
accurate and efficient billing processes for
pulmonary function tests, diagnostic testing,
therapy sessions, and other related services. Our
team of skilled professionals understands the
complexities of pulmonary coding guidelines and
ensures compliance with industry standards. MDS
helps healthcare providers optimize revenue and
streamline their billing operations, allowing
them to focus on delivering high-quality
pulmonary care to their patients. For detailed
understanding on pulmonary billing services,
contact us at info_at_medisysdata.com / 888-720-8884.
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