Wiki Pulmonolgy Function Test Coding

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tylene1993

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I am in need of some help. We are billing for the physician interpretation of Pulmonary Function Tests. Our physician does not think that we are using the correct code for the physician interpretation. We are billing 94016. Is this the correct for the interpretation of a Pulmonary Function Test? Any help would be appreciated. :confused:
 
Normally, for a read only, we would append a 26 modifier to one of the following sets of codes. These are the tests our physicians agreed should be in a 'complete PFT' for an adult. Not all PFT's include the same codes/tests. I would check the tests being performed as part of the PFT prior to billing. Age may also effect the codes if the patient is 2 and under.

94010 - 26 or 94060 - 26 (pre and post)
94726 - 26 94726 - 26
94729 - 26 94729 - 26

Hope this helps!

Ann C. Moore, CPC, CPPM
 
Pulmonology Function Test Coding

Thank you for your help. Also, my pulmonogist is doing what he calls MIPs and MEPs which he said consists of respiratory muscle strength testing as well as vital capacity testing. What codes would you use for these tests? :)
 
PFT Billing Please help!

We continue to have code 94016 denied by MCR whether it has modifier 26 on it or not. (They have been denied both ways). This billing is for read only, physician is employed by hospital, hospital owns equipment. what are we doing wrong??

Thanks for any help!
 
Cpt 94016

Not certain, but from what you have shared I am wondering if you are using the correct CPT code. From CPT Assistant 1999 Pulmonary Function Testing, page 8

94016 - Patient initiated spirometric recording per 30 day period of time; physician review and interpretation only

Patient Initiated Spirometric Recording

This method of obtaining ongoing spirometric analysis of lung function is relatively new, but is widely accepted in both the pulmonary medicine and transplant community. Patient initiated spirometric recording is currently being used following lung transplant and requires the patient to perform the spirometry at a predetermined time each day. The results are stored in a small computer that is part of the spirometer. At a scheduled time, the patient is contacted and the data is downloaded via modem from the spirometer's computer to another computer. The data is then trended and analyzed to identify problems such as rejection, infection, or bronchiolitis obliterans following lung transplant.

I also located LCD L34541 (CGS Administrators, LLC) which states the following regarding CPT codes 94014 - 94016:

Spirometry is a non-invasive technique that measures the vital capacity, forced expired volume in one second, and rates airflow at various lung volumes. Measurement of the forced vital capacity and corresponding flow rates is the most commonly used test to detect the presence of lung disease and to monitor changes in severity and response to treatment.

Patient-initiated spirometric recording per 30-day period of time includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation.

The use of peak flow meters by patients, and their recording and reporting of the results to their physician, has been a standard means of monitoring patients with pulmonary dysfunction at home.

Computerized capture of data and electronic transmission of the results has not been demonstrated to offer additional new benefits to patients in the management of their pulmonary dysfunction.

Transtelephonic spirometry has also been investigated in lung heart-lung transplant recipients who underwent monitoring of lung rejection with home spirometry. The small number of patients studied to date does not permit scientific conclusions regarding the utility of home monitoring in this clinical setting.

Transtelephonic spirometry is considered to be of unproven benefit as there is inadequate evidence that its use will significantly affect the care of lung transplant recipients, asthmatics, and persons with other chronic pulmonary disorders/diseases (e.g., emphysema). These services will be denied as not reasonable and necessary.

Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators to process their claims.

Hope this information helps!
 
MzItsy said:
PFT Billing Please help!

We continue to have code 94016 denied by MCR whether it has modifier 26 on it or not. (They have been denied both ways). This billing is for read only, physician is employed by hospital, hospital owns equipment. what are we doing wrong??

Thanks for any help!
Click to expand...
I agree with the information provided by coder1965. Also, the description for CPT code 94016 includes the "professional component"; therefore the modifier should not be needed. What diagnosis code were you billing? According to the LCD, this procedure is only covered for lung transplant patients; all other diagnoses are considered investigational and experimental and are not covered by Medicare. I have seen some Medicaid payers, such as Aetna Better Health of KY and KY Medicaid reimbursement for these services. I'm sure this is not helpful 8 years later, but hopefully this will help someone! :)
 
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