Pulmonology Coding Alert

Question: Which pulmonary function tests (PFTs) cannot be reported together on the same date of service?

Pennsylvania Subscriber

Answer: When the pulmonologist reports PFTs, choosing the correct CPT codes depends on the extent of the testing performed and documented. And, when choosing the appropriate codes for PFTs, you should consult the Correct Coding Initiative (CCI) edits, which identify procedure codes that have been classified as mutually exclusive or components of a comprehensive code. Reviewing these edits will help you identify which procedure codes can be reported to prevent potential billing errors such as unbundling.

Unbundling occurs when a pulmonologist bills for two or more procedures that CCI combines into one comprehensive code. For example, two of the most common PFTs are 94375 (Respiratory flow volume loop) and 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). CCI identifies 94375 as a component of 94010. Code 94375 will always be denied when reported with 94010. The 94375 is an alternative method of calculating a standard spirometric parameter and, as such, is bundled into the comprehensive 94010.

Answers for You Be the Coder and Reader Questions were provided by Carol Pohlig, BSN, RN, CPC, at the University of Pennsylvania department of medicine in Philadelphia; and Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Societys Clinical Practice Committee.