Pulmonology Coding Alert
Use 94011-94012 for Patients Under 2 Years Old
Question: I’m new to pulmonology coding and having difficulty with the following case. Parents of a 15-month-old patient brought their child into an outpatient pulmonology practice for spirometry. The documentation states the patient presented with complaints of shortness of breath, and the child’s pediatrician wants the pulmonologist to assess the patient’s breathing performance. The documentation lists the procedure as measurement of spirometric forced expiratory flows without and with bronchodilation. Can I report the case with 94060? Texas Subscriber Answer: No, you won’t use 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) to report this case. Instead, you’ll assign 94012 (Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age) since the patient was under 24 months old. The procedure is a pulmonary function test (PFT) where the pulmonologist safely, yet forcibly, exhales the air from the child’s lungs. During the test, the physician measures the forced exhaled airflow to evaluate the patient for lung disease or other issues, assess the airway function, and gauge which therapies will be best for the patient. The provider then interprets the data and records the results. In the case of your situation, the provider performs the test without a bronchodilator, then administers a bronchodilator and performs the test again. The physician compares each component of the test to see if the bronchodilator opens the airways for better respiratory function. This supports 94012. Code 94011 (Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age) is only reported when the provider performs the same PFT without the use of any bronchodilation. Important: Do not report both 94011 and 94012 on the same date. National Correct Coding Initiative (NCCI) edits only allow one of these codes to be reported on a given date.
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