Pulmonology Coding Alert

Question: When our physician performs a plethysmography, we bill a 93720 (plethysmography, total body; with interpretation and report). However, the insurance company lately hasnt been paying for this service. Medicare has never paid it. How can we solve this problem?

William Lahs Practice Manager
Beverly Hills, Calif.

Answer: It is important to be clear that you are using 93720 at the appropriate time. Code 93720 describes a diagnostic pulmonary evaluation that measures thoracic gas volume, compliance of the lung, airway resistance and airway conductance. Report code 93720 when:

1. The physician performs the testing.
2. The physician supplies the equipment and
technician.
3. The physician provides a written interpretation of the plethysmography report.

Code 93721 (tracing only, without interpretation and report) is to be used by the facility providing the equipment and technician when that facility is a separate entity from the physician practice.

When the physician is providing the separate interpretation of the test that is performed on equipment owned by an independent facility, then the physician should bill 93722 (interpretation and report only). Modifier -26 should never be used with this code, since by definition it represents the professional component of the service.