Pulmonology Coding Alert

Question: Our pulmonologist frequently undertakes methacholine challenge tests. But, sometimes he uses histamine for a challenge test. I know you should report 94070 to code the procedure. But, how do I report the histamine that he used for the challenge test? I am not finding any suitable code to report this.

California Subscriber

Answer: You are right in reporting 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine]) for a methacholine challenge test performed by your pulmonologist to assess the response of the patient's airways to bronchospasm. The same code is used to report the test if other agents such as provocholine, histamine or cold air is used to assess the patient's airways. If you are reporting services in a facility-based lab, your physician can only report 94070-26 to represent the professional component of this service. The facility will report 94070-TC as well as the codes for administration of the inhalation solution (95070 " a technical only code) and the supply.

If your physician practices in a private setting in which place of service 11 (physician office) can be used. Your physician can report 94070 and 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) in addition to the supply code. If methacholine is used for the test, you will need to report an additional J code to report the supply of the methacholine. So you will need to report J7674 (Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg) for every 1mg of methacholine used.

But when your pulmonologist uses histamine for the bronchospasm provocation evaluation, you need to note that there is no separate J code to report the supply of histamine used for the procedure. For this reason, you will need to use an unlisted inhalation solution code to report the supply of the histamine. So you will need to report J7699 (NOC drugs, inhalation solution administered through DME) or 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) to report the histamine supply.

The most important thing that you need to note when you are reporting J7699 or 99070 is that you will need to provide proper documentation to the insurance carrier or else you will risk the possibility of denials to your claim. In the documentation, you will need to include the name of the drug (histamine) that your pulmonologist used for the procedure along with the quantity used. You will also have to provide the cost of the histamine as these codes do not have a pre-assigned fee.