Revenue Cycle Insider

Question: The practitioner performed a pulmonary function test (PFT) twice on the same date of service on the same patient. Are we able to bill the same CPT^® code twice?

AAPC Forum Participant

Answer: The answer will depend on the scenario. Let’s review a few possibilities together.

Scenario 1: The provider performs a PFT such as spirometry on a patient, but the values end up being inconclusive, and additional testing is required on the same day to make a definitive diagnosis. In this case, you’d add 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) twice to your claim and append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to the second test.

Important: Your documentation will need to be thorough to prove medical necessity for the repeat and same-day testing in this instance. Also, do not report 94010 twice if the first test was incomplete due to failure of equipment or the patient’s inability to follow the practitioner’s instructions.

Scenario 2: If the provider performed multiple spirometry tests with specific stimulants to evaluate the patient for bronchospasm in response to the agents, you’d assign 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)). There is no need to add modifier 76 in this case because the descriptor allows for “multiple spirometric determinations,” which means that the provider can perform the test as many times as necessary to evaluate the patient’s condition.

Scenario 3: Let’s say the provider performed 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre-and post-bronchodilator administration). For this testing, you would only report the code once and without any modifiers, because the repetition of the spirometry is already mentioned within the code descriptor.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC