Reading ONLY of a PFT

[scrawford1690@gmail.com]

Hi,

Can anyone help me figure out how to charge for only a reading and interpretation of a PFT?

Thanks!!

 

[Pam Warren]

with the -26 modifier, if the PFT has a Professional/technical split. Make sure the provider documents a report. I'm assuming the PFT is being done elsewhere.

 

[scrawford1690@gmail.com]

with the -26 modifier, if the PFT has a Professional/technical split. Make sure the provider documents a report. I'm assuming the PFT is being done elsewhere.

thanks for your reply! I'm still confused about this one...

The doctor didn't order the PFT or perform it. He is only reading and interpreting them. When the patient comes in for an office visit I can use this to count towards the E&M level as a data point correct?

Sometimes the doctor also just reads and interprets the PFT, without the patient having a visit. These PFT's are also not ordered by him and done somewhere else. In this case is there any code I can use for him to be reimbursed? Would this be the 94010-26?

 

[csperoni]

If your physician is reading and interpreting the PFT with report/findings, then 94010-26 would be appropriate. If you are billing 94010-26, you may NOT then count it toward data on E/M leveling.
If your physician is reading and more informally interpreting the PFT without a report but still noting their evaluation of the test, then I would not recommend billing 94010-26. In this scenario, it can be counted toward data on E/M leveling as independent interpretation.
Independent interpretation: The interpretation of a test for which there is a CPT code and an interpretation or report is customary. This does not apply when the physician or other qualified health care professional is reporting the service or has previously reported the service for the patient. A form of interpretation should be documented but need not conform to the usual standards of a complete report for the test.
If your physician is reviewing the PFT without independent interpretation, then I would count it for E/M leveling as review of a test.

For you last scenario, read and interpret PFT without a visit, if he is providing a complete report, then 94010-26 could be used.

For tests (not PFTs, but imaging) I will note that my physicians usually read the report, occasionally do independent interpretation, but never with their own report in order to consider -26. I don't know carrier policies, but my initial instinct is to question the medical necessity of a second physician to read and report on a PFT.

I hope that helps better explain it.

 

[karotwo]

So what is a complete PFT? My provider orders but we only charge to read . The sheets have Spirometry- pre and post Bronch, Lung Volumes, Diffusion, Airway Resistance .
Is this the complete PFT with 94060-26?

 

[csperoni]

If you are ordering, not performing, and then reading and interpreting the findings with report, then the code with -26 is usually appropriate. I don't code for pulm, but it does sound like you are describing 94060.
94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration