Examine This Guide to Common Pulmonary Procedure Codes – Part 1
Pulmonary medicine encompasses a wide range of services, from basic diagnostic tests to advanced therapeutic procedures. This can present unique challenges for coders since pulmonary codes can cross into other sections of CPT®, including radiology, critical care, and surgery. In this first article of a two-part series, Revenue Cycle Insider will highlight commonly reported pulmonary CPT® codes for pulmonary function testing and stress tests. Understanding Types of Lung Disease There are two broad categories of lung disease: obstructive lung disease and restrictive lung disease. Both can cause symptoms like shortness of breath, but the difference lies in when the symptoms occur during breathing. Obstructive lung diseases cause difficulty with exhaling due to obstruction in the air passages. Obstructions may result from mucus, inflammation, muscle spasms, or weakened/collapsed airways. These narrow or blocked passages prevent airways from staying open long enough for complete exhalation, leading to air trapping. Examples include asthma and chronic obstructive pulmonary disease (COPD). Restrictive lung diseases (RLD) make it harder to inhale because of reduced total lung capacity or the inability of the lungs to fully expand and fill with air. Causes of RLD can include the following factors: Prepare to Code Pulmonary Function Tests Pulmonary function testing is one of the most frequently performed diagnostic services. It is a group of noninvasive breathing tests that measure lung intake and exhale efficiency as well as oxygen transfer into the blood. Common services include spirometry, lung volume measurement, and diffusion capacity testing. Spirometry testing measures how much air and how quickly a patient can inhale and exhale. This test is the foundation of pulmonary function testing. Use 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation) when the pulmonologist performs spirometry. This is a basic breathing test that measures how much air is breathed in and out and how fast it can be blown out. Code 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) is a spirometry test performed before and after bronchodilation administration. The test measures reversibility with medication administration. The code is commonly billed in conjunction with 94010, so you should review payer guidance before billing the two codes together. Respiratory flow volume loop testing, reported with 94375 (Respiratory flow volume loop), expands on spirometry by measuring both inhale and exhale flow to produce a full flow-volume loop. Bundling issues do exist between 94375 when billed with 94010 or 94060, but there are no bundling issues when billed with 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance). Refer to the National Correct Coding Initiative (NCCI) edits for modifier instructions. Lung volume measurement determines the total amount of air the lungs can hold and identifies disorders where lung expansion is limited. Use 94726 to report plethysmography. The service is also called a “body box test” or lung volume test. During the testing, the patient sits inside a clear, airtight booth and breathes through a mouthpiece. The box measures pressure changes. Report diffusion capacity testing with 94729 (Diffusing capacity (e.g., carbon monoxide, membrane) (List separately in addition to code for primary procedure)). The patient breathes in a small amount of gas while a machine measures how much gas is absorbed into the blood. This service checks how well the lungs are exchanging oxygen with blood. Coding tip: Codes 94726 and 94729 include technical and professional components, reported with TC (Technical component …) and 26 (Professional component), respectively, when the provider performs only one portion of the service. Check Oxygen Saturation With Pulse Ox Pulse oximetry codes are used to report noninvasive measurement of oxygen saturation using a finger, toe, or earlobe probe. This is considered part of the physical exam when performed as part of routine clinical monitoring. The service may be separately reportable when performed as a distinct medical service. Report 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) when a pulmonologist places a sensor on the patient’s finger or earlobe to measure oxygen levels. This code is designated for one reading. Assign 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)) when the provider captures multiple readings. During the service, the pulmonologist places the sensor on the patient’s finger or earlobe to measure oxygen levels for multiple readings during a visit or during an activity, such as a six-minute walk test. Report 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)) when a sensor is placed on the finger or earlobe to measure oxygen levels overnight while sleeping. This service monitors the patient’s pulse ox continuously, not just spot checks. The pulse oximetry may also be used during sleep studies. Coding tip: Codes 94760, 94761, and 94762 are bundled into critical care evaluation and management (E/M) codes 99291 and +99292 (Critical care, evaluation and management of the critically ill or critically injured patient …). Code 94760 is considered a bundled service by some payers. Review payer guidance before billing. On the other hand, 94761 and 94762 may be performed alone or as a component of a more complex service and not separately payable. If billable, a modifier may be required. Review payer guidance for billing. Stretch Your Stress Test Coding Knowledge Exercise and cardiopulmonary testing procedures evaluate how the lungs, heart, and circulatory system respond to physical exertion. You’ll report the following codes for these procedures: Coding tip: The codes can be billed with the global package or broken out into technical and professional components. Do not report 94060 or 94760-94762 separately as the services are included in the CPT® codes listed above. Next month, Revenue Cycle Insider will examine the CPT® and HCPCS Level II codes for sleep studies and therapeutic services. Dawnelle Sager, CPC, CPMA, CPC-I, CRC, Professional Fee Coding & Compliance Auditor,
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