Pulmonology Coding Alert

Question: Our pulmonologist recently administered a histamine challenge test? She also performed vital capacity and plethysmography. How should I code this scenario? What should I code for the actual Histamine supply? 

New York Subscriber

Answer: For the Histamine challenge test, you should report 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds).  

You should report 94726 (Plethysmography for determination of lung volumes and, when performed, airway resistance) for the plethysmography and 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine]) if multiple spirometric determinations are performed after the agent is administered. 

Code 94150 (Vital capacity, total [separate procedure]) is assigned a “B” status in the Physician Fee Schedule, which means that the payment for this code is always bundled into payment for other services not specified. These and some other tests such as maximum breathing capacity, pulmonary stress testing, and diffusing capacity may be administered to the patient along with the histamine challenge to test lung function. Pulmonologists most frequently perform the bronchial provocation challenge with methacholine (also reported as 94070, 95070) and less often with histamine. There is a direct code (J7674, Methacholine chloride administered as inhalation solution through a nebulizer, per 1mg) in case of methacholine but if your pulmonologist provides histamine, your reporting options are limited. 

Because there is no specific J code to accurately reflect the histamine substance, the unlisted inhalation solution code (J7699, NOC drugs, inhalation solution administered through DME) is your only option when billing is permitted. The unlisted code doesn’t carry a description or a fee, so you and your physician must assign them. 

When you submit a claim to Medicare for unlisted drugs and/or services, always include a description and fee on the claim. It is likely Medicare will deny your claim pending review of additionally requested information. Medicare will determine coverage, medical necessity, and payment upon review.

Note: The NDC is an 11-digit National Drug Code that assists in identifying the drug and its manufacturer. Unlisted codes don’t have a specific NDC number assigned to them. 

Medicare provides coverage for certain drugs used by physicians and providers under certain conditions. You can find the list of Medicare Part B covered drugs and payment at www.cms.hhs.gov/providers/drugs/asp.asp.