Primary Care Coding Alert

Family physicians (FPs) often perform spirometry (94010) and bronchospasm (94060) tests on patients with respiratory problems. Combined with other pulmonary function test (PFT) codes, office visits and complex treatments, they present a number of challenges. To optimize reimbursement for these commonly performed tests, coders must know how the tests work with one another and how they affect billing when combined with other procedures.
 
Knowing exactly what the spirometry and broncho-spasm tests are will help coders understand why theyre bundled, says Kathy Pride, CPC, CCS-P, HIM application specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif. There are still practices that try to code these separately, but the bronchospasm evaluation includes spirometry, so theyre always denied.
 
A spirometry measures lung volume and function (the rate at which you blow air in and out). The patient blows into a tube hooked up to a sensor that calculates the measurements. An FP performs spirometry to help diagnose chronic obstructive pulmonary disease (COPD) and to check on asthmatic patients and patients with shortness of breath. Coders bill spirometry with 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation).
 
The bronchospasm test is almost identical to spirometry. First, a spirometry test is performed, then the physician would administer a bronchodilator to dilate the airways, after which another spirometry would be done. The bronchodilator is typically in aerosol form (such as an albuterol inhaler) and helps determine if the patient has reactive airways. Coders should use 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) to report bronchospasm tests. 
PFT Scenarios Illustrate Coding Options  
The following case studies illustrate how to code for these PFTs:
 
Scenario #1: A 65-year-old new patient who has been smoking for 45 years presents with shortness of breath. The FP performs a detailed history and an expanded problem-focused exam, and decides that spirometry would help diagnose COPD. The patient has decreased readings on the first spirometry, so the physician uses albuterol and readministers the test. Readings from the second test are greatly improved. The FP diagnoses the patient with reactive airway disease and probable COPD. 
 
Coding Scenario #1: The correct code is 94060 because the albuterol inhaler is used. The diagnosis code is 493.12 (Intrinsic asthma; with acute exacerbation) because the patient is having an acute exacerbation (shortness of breath). An E/M visit can be coded separately as well, says Pride. Use 99202 (Office or other outpatient visit for the evaluation and management of a new patient ) with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other [...]