Pulmonology Coding Alert

Question: I am going to bill 94150 and 94726. The CCI edits do not show the codes bundled but the McKesson edits do. Can you provide a full description of the tests?

Kansas Subscriber

Answer: In this test (94150, Vital capacity, total [separate procedure]), the provider measures the total vital capacity of the patient. Vital capacity is the volume of gas that the patient can expel from the lungs from a position of full inspiration. This test is administrated as a basic measurement part of spirometry, which is the study of air volume and flow rate within lungs. Vital capacity is the volume of air measured during a slow maximal expiration after a maximal inspiration. Its normal range may vary with age, sex, and height. The provider performs this test to diagnose and manage lung disease.

To measure the vital capacity, the provider instructs the patient to inhale to his greatest lung volume and then exhale until he can no longer expel air. The vital capacity is usually recorded in liters or milliliters. Usually, the provider performs the vital capacity as a part of a larger procedure. If so, you should include the test in that procedure code rather than reporting this code.

Vital: McKesson ClaimCheck™ closely follows CMS Medicare CCI edits itself. Therefore, McKesson also recommends providers to also follow CMS Medicare CCI edits, CPT™ regulations and Mutually Exclusive Edits (MUE). Medicare assigns 94150 a “Bundled” status. According to CMS, this means that “payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amount for these codes, and no separate payment is made.”

You will report 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) for lung volume testing as part of pulmonary function test, or PFT, to determine the patient’s lung volumes, such as total lung capacity, residual volume, and functional residual capacity. The testing also may include checking airway resistance.

The patient is made to sit in a specially designed small room, often called a body box. A mouthpiece attached to a measuring device measures volume and pressure changes as the patient breathes. Another approach uses belts wrapped around the patient to sense changes in the chest and abdomen. The provider may also ask the patient to perform panting to check airway resistance.

The provider interpreting the results reviews the pressure volume curves created during testing as well as the pressure and flow results if the patient also completed the airway resistance test. The provider checks for errors, interprets the results, and documents the interpretation in the medical record. This test is usually ordered for patients with symptoms affecting the lungs, such as shortness of breath, or conditions such as emphysema or lung cancer.

Code 94726 cannot be reported in conjunction with 94727 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) and 94728 (Airway resistance by impulse oscillometry).