Pulmonology Coding Alert

We've got the spirometry and allergy coding answers you've been searching for

To properly code asthma treatments, you should know when to unbundle spirometry and bronchodilator codes, how to document nebulizer training, and the difference between percutaneous and intracutaneous allergy tests.

Review the following expert answers to your most pressing asthma-related questions to ensure your practice receives its deserved reimbursement.

1. How should I report the initial pulmonary function tests (PFTs)?

If the patient comes to the office with a chronic cough (786.2), wheezing (786.07), or shortness of breath (786.05), your physician may administer a baseline spirometry to check for asthma. In such cases, list the spirometry as 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). (For more on coding spirometries, see "Forfeiting $50 a Pop on 94014: Are You at Risk?".)

Suppose the spirometry reveals that the patient has decreased lung function consistent with asthma (493.xx). The physician may administer a bronchodilator to relax the patient's bronchial tubes and retest the patient's pulmonary function. You should report this procedure as 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]), says Denae M. Merrill, CPC, a pulmonary coder in Saginaw, Mich.

Important: You should use only 94060 to report the bronchodilator and spirometry, when the physician performs both procedures. Code 94060's descriptor includes the spirometry service (94010), and the National Correct Coding Initiative (NCCI) bundles the two codes.

Exception: If the physician gives the patient a baseline spirometry one day, and then the next day the patient needs a bronchodilator, you can report 94010 and 94060 separately, Merrill says.

And, if the nurse provides the bronchodilator, the physician should be present in the office suite in case the patient has a severe asthma attack, says Darcy Crabb, a patient account representative for Pulmonary Associates in Sioux City, Iowa.

Methacholine May Determine Disorder

Sometimes the pulmonologist performs a methacholine challenge test to determine the breathing disorder when the spirometry results are normal. You should report this test as 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds).

And, you may assign 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) to describe the PFT that measures the methacholine's impact, Merrill says.

If the physician performs the methacholine procedure in a hospital or other facility setting, you may report 94070-26 (Prolonged postexposure evaluation of bronchospasm...; professional component) for his professional services, Crabb says. The hospital will bill 95070 for the technical services, she adds.

2. How can I distinguish between nebulizer codes 94640 and 94664?

Remember that if the pulmonologist treats a patient's asthma attack with inhalation treatment, you should assign 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]). This code presents the inhalation administration.

Typically, a nurse or other medical staff administers the inhalation treatments, so you should report the services as "incident-to." Reporting a service incident-to allows your physician to get paid for the nurse's work, as long as the physician supervised the service.

For example, the nurse administers the inhalation treatment multiple times to relieve the patient's symptoms. For the first procedure, list 94640 as an incident-to service, which lets the carrier know the nurse performed the procedure under the physician's supervision.

For each subsequent procedure, make sure you attach modifier -76 (Repeat procedure by same physician) to the 94640, Merrill says. The modifier lets the carrier know your physician needed to perform the procedure several times for an appropriate clinical response, she adds.

But when either the pulmonologist or nurse trains a patient on how to use an aerosol generator or other nebulizer device, you should report 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).  Code 94664 describes the education and/or demonstration. 

Documentation tip: The 94664 claim's documentation should include the following details: