Pulmonology Coding Alert

Reader Questions:

Modify 94060 to Report Reading of Results

Published on Fri Jul 08, 2022

Question: I have a report that says the physician only read and interpreted the findings of spirometry. The report documents spirometry, pre- and post-bronchodilator, lung volumes, diffusion, and airway resistance. The physician didn’t order the pulmonary function test (PFT) or perform it, they just read and interpreted the results.

I’m new to pulmonology, so could you please explain which codes to assign?

Ohio Subscriber

Answer: You’ll start by assigning 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) to report the spirometry procedure. Code 94060 is a spirometry test where the provider captures measurements before and after administering a bronchodilator. This code includes lung volume measurements.

CPT^®guidelines before the pulmonology codes in the code set state that 94060 includes “laboratory procedure(s) and interpretation of test results.” However, you stated the physician only read and interpreted the results and didn’t perform the procedure. In this case, you’ll need to append modifier 26 (Professional component) to 94060.

Note: You should report 94060-26 if the physician provided the formal interpretation of the study. If the physician sees a patient in the office and over-reads someone else’s formal interpretation (e.g., looks at the tracings/data and independently interprets the information), you should not report that procedure separately. The latter should be incorporated into the medical decision making (MDM) complexity associated with the evaluation and management (E/M) visit.