Pediatric Coding Alert

Question: When billing for two spirometries — a pre- and post-spirometry — during the same visit, should I bill 94010 for the first spirometry and 94060 for the second reading? Or should I use 94060-25 x 2 units for both readings?

Tennessee Subscriber

Answer: In order to bill this encounter correctly, you must first determine exactly what your pediatrician performed. If the pediatrician performed the spirometries without bronchodilation, you would report 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation).

However, if your patient received a bronchodilator treatment in addition to the spirometry, you would report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration). Per the wording of the descriptor, the spirometry service is included in the bronchodilation, so you would not be able to bill 94010 with 94060. This is reinforced by the Correct Coding Initiative (CCI), which makes 94060 a Column 2, or component code, for 94010.

This CCI edit does have a modifier indicator of 1, meaning that it is technically possible to unbundle to two codes using a modifier. However, you would not use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to do so as, per the language of the modifier, it is only to be used on an evaluation and management (E/M) service such as 99201-99215, and not on a procedure code.

To unbundle procedures, you would use modifier 59 (Distinct procedural service). However, in this case, only one code describes the service your pediatrician performed, and you would not report both codes with any modifier.

As for the number of units to bill, the clinical responsibility in both services is to measure the flow of air in and out of the lungs while the patient is inhaling and exhaling. To do this, the provider administering the test may perform it several times in order to get the best possible result. So, the number of units would be immaterial if you decide to bill 94010, as it would be if you billed 94060, which records the lung capacity both before and after bronchodilation.

In other words, you should bill one unit of the single most comprehensive code for the session with no modifier attached.