Pulmonology Coding Alert

Question: A patient comes in for a consult that an internist requested based on the patient’s CT result. The pulmonologist performs a PFT in the office. He interprets the test and sends it to the primary care physician. Should I bill for only the PFT or may I also report 99244 with modifier 25?


Virginia Subscriber

Answer: You should bill for both the PFT and the consultation. Here’s how:

PFT: Because your physician practices in a private office setting and owns the equipment, you should bill the global spirometric code, such as 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) -- without modifier 26 (Professional component).

Consult: You also do not need a modifier on the E/M code. The National Correct Coding Initiative (NCCI) does not bundle consultations (such as 99244, Office consultation for a new or established patient …) with spirometry codes.

Catch: Non-Medicare insurers may require use of modifier 25 (Separate, significantly identifiable evaluation and management service by the same physician on the same day of a procedure or other service). If a payer denies payment of the E/M service when provided on the same day as any other “procedural” service, try appending modifier 25 to the E/M code.