Part B Insider (Multispecialty) Coding Alert

Published on Tue May 03, 2011 PDF

Question: My physician wants me to bill separately for a spirogram and methacholine test performed on a patient on the same day. Should I be concerned with any bundles?

Answer: You may report a spirogram (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and a methacholine test (94070, Bronchospasm provocation evaluation,multiple spirometric determinations as in 94010, with administered agents [e.g., antigen(s), cold air, methacholine]) separately only if the physician performs the spirogram before the methacholine test.

Say a patient with dyspnea sees the pulmonologist for a spirogram. After the results have come out normal, the physician decides to perform a methacholine challenge test to determine how responsive the patient's airways are. You would report 94010 and 94070, appending modifier 59 (Distinct procedural service) to the spirometry code.

Reminder: The Correct Coding Initiative (CCI) imposes a bundle on 94010 and 94070, but you can override it by using modifier 59 as appropriate when the spirogram precedes the methacholine test. Bill only 94070 if the spirogram happens after the methacholine test since the spirogram may not provide additional, diagnostic information above the information received from the methacholine challenge.