Internal Medicine Coding Alert

Published on Fri Mar 03, 2006 PDF

Question: What is the difference between codes 94070 and 95070?


Indiana Subscriber

Answer: The first difference you may notice between 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]) and 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) is that 94070 is listed in the Pulmonary section of the CPT manual and 95070 is listed in the Allergy and Clinical Immunology section.

When a pulmonary function technologist exposes a patient to a substance, such as methacholine, and conducts spirometric testing on the patient to evaluate bronchospasm provocation, you would report 94070 indicating that the technologist performed multiple spirometric assessments after the challenge.

You would also report 95070 for the delivery of the methacholine and J7674 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg) for each milligram of methacholine administered.

If the physician administered cold air or an antigen as the bronchial challenge, you would report 95071 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with antigens or gases, specify).

Bottom line: If your internist is testing the patient for a condition such as asthma, using an inhalational challenge, report 95070 or 95071 for the administration of the challenge substance, and 94070 for the multiple spirometric measurements performed after the challenge.
 
If your physician provides this service in a facility PFT lab, he may only report the professional component of the services. You should append modifier 26 (Professional component) to the service code. You'll report 94070-26.

The facility will report the technical services using codes 94070-TC and 95070. Code 95070 represents a technical service only and has no physician work RVUs.