Pulmonology Coding Alert

5 easy steps to proper coding

When your pulmonologist administers a methacholine challenge test (95070) to treat a patient's respiratory problem, you need to know how to properly code multiple spirometries and attach the correct modifiers for your physician's work. Follow the expert advice below, and you'll find methacholine testing not as challenging as you may think. 1. Report Professional and Technical Components Use 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) for the methacholine administration, says Sharon Tucker, CPC, president of Seminars Plus in Fountain Valley, Calif.

This code does not include payment for the pulmonary function tests (PFTs) required to evaluate the patient's prolonged postexposure bronchospasm, so you should report 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics) for the postexposure bronchospasm evaluation in addition to 95070.

Pulmonologists use methacholine provocation challenge tests (95070) to determine if a patient has respiratory diseases such as bronchial asthma (493.9x). Physicians perform spirometries after each methacholine inhalation to measure the patient's airway responsiveness and to determine if the patient exhibits a bronchospastic response (519.1).   

Typically, physicians perform methacholine studies in a hospital's pulmonary function testing lab. When this occurs, each "entity" reports its portion of the service. In other words, the pulmonary function lab will report the methacholine administration (95070) in addition to the evaluation's "technical" portion. That is, the lab will list 94070-TC for the spirometric measurements. Your physician will report his or her "professional" portion, which includes interpreting the spirometric measurements (94070-26), says Kelley L. Emig, LPN, CPC, CHCC, a coding specialist with Coding and Reimbursement Solutions Inc., in Port St. Lucie, Fla.

Remember that you can report 94070 only once, not for each unit of service, Tucker says. For instance, if your physician performs multiple spirometries, you cannot report 94070 or 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) for each test. 2. Check the Report for Appropriate FEV1 Drop Methacholine testing measures patients' levels of forced expiratory volume in one second (FEV1). So you should watch for these measurements in the report to support medical necessity for the tests, coding experts say.

For instance, your pulmonologist may examine an established patient (99211-99215) for shortness of breath (786.05) and evaluate the patient's labored breathing. As part of the evaluation, your physician performs a spirometry (94010) to measure the patient's respiratory function, which is near normal. 

The patient's symptoms lead your pulmonologist to suspect asthma (493.xx), so he or she orders a methacholine challenge test in the PFT lab. The patient receives the methacholine in the [...]