Coding for pulmonary function tests (PFTs) is an important aspect of healthcare billing and reimbursement. These tests are used to evaluate lung function and can be useful in diagnosing and monitoring respiratory conditions such as asthma, COPD, and pulmonary fibrosis. There are several different types of PFTs, each with its own specific set of CPT codes that healthcare providers must use for billing purposes. Understanding the correct codes to use for each type of test is essential for accurate billing and reimbursement, as well as for ensuring that patients receive the appropriate care for their respiratory conditions. In this article, we will explore the various types of PFTs and the CPT and diagnosis codes associated with them.
Coding for Pulmonary Function Tests
CPT Codes for Pulmonary Function Tests
Pulmonary function tests (PFTs) are used to evaluate lung function and diagnose or monitor respiratory conditions. There are several types of PFTs, including spirometry, lung volume determination, diffusion capacity testing, bronchial provocation testing, and pulmonary stress testing. Each type of test has its own set of Current Procedural Terminology (CPT) codes, which healthcare providers and their billing and coding staff must use in order to ensure accurate billing and reimbursement. Pulmonary function tests and applicable CPT codes are as follows:
1. CPT Codes for Spirometry Test
Spirometry is a type of pulmonary function test (PFT) that measures how much air a person can exhale and how quickly they can do so. It’s a common test used to diagnose and monitor respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and lung fibrosis. There are several CPT codes related to spirometry, which healthcare providers use to bill for this service. Here’s a breakdown of what each code represents:
- 94010: This code is used for a basic spirometry test, which measures how much air a patient can exhale in one breath.
- 94011: This code is used for a prolonged spirometry test, which measures how much air a patient can exhale over a longer period of time.
- 94012: This code is used for a spirometry test with a bronchodilator, which measures how much air a patient can exhale before and after using a medication that opens up the airways.
- 94060: This code is used for a spirometry test with a pre- and post-bronchodilator, which measures how much air a patient can exhale before and after using a bronchodilator medication.
- 94070: This code is used for a spirometry test with a bronchial challenge, which measures how the airways respond to a substance that may trigger asthma symptoms.
- 94150: This code is used for a comprehensive respiratory assessment, which may include spirometry as well as other tests to evaluate lung function.
- 94200: This code is used for maximal voluntary ventilation (MVV) testing, which measures how much air a patient can inhale and exhale in one minute.
- 94375: This code is used for a capnography test, which measures the amount of carbon dioxide a patient exhales.
- 94726: This code is used for lung volume measurement, which measures the amount of air in the lungs at different points in the breathing cycle.
- 94727: This code is used for gas diffusion testing, which measures how well oxygen and carbon dioxide move between the lungs and the blood.
2. CPT Codes for Lung Volume Test
Lung volume determination is a type of pulmonary function testing (PFT) that measures the amount of air in the lungs at different points in the breathing cycle. This type of testing can be useful in diagnosing and monitoring respiratory conditions such as chronic obstructive pulmonary disease (COPD), emphysema, and interstitial lung disease. There are several CPT codes related to lung volume determination. Here’s a breakdown of what each code represents:
- 94013: This code is used for multiple-breath helium dilution or nitrogen washout testing, which is a type of lung volume determination test.
- 94726: This code is used for plethysmography, which is a type of lung volume determination test that measures the amount of air in the lungs at the end of a full inhalation.
- 94727: This code is used for gas diffusion testing, which measures how well oxygen and carbon dioxide move between the lungs and the blood. While this test is not specifically a lung volume determination test, it is often performed along with other PFTs to provide a more complete picture of lung function.
- 94728: This code is used for pressure-volume loops, which is a more complex type of lung volume determination test that is typically used in research settings.
3. CPT Codes for Diffusion Capacity Test
Diffusion capacity is a type of pulmonary function testing (PFT) that measures how well oxygen and carbon dioxide move between the lungs and the blood. This type of testing can be useful in diagnosing and monitoring respiratory conditions such as pulmonary fibrosis, emphysema, and pulmonary hypertension. The CPT code for diffusion capacity testing is 94729. This code is used for single-breath carbon monoxide diffusing capacity (DLCO) testing, which is the most commonly used method for measuring diffusion capacity.
During a DLCO test, the patient inhales a small amount of carbon monoxide and holds their breath for a short period of time before exhaling. The amount of carbon monoxide that is absorbed by the lungs is then measured, along with the amount of air that the patient breathed in and out during the test. This information is used to calculate the diffusion capacity of the lungs.
It’s important to note that healthcare providers should only order DLCO testing that is clinically necessary for the patient’s condition. Medicare and other insurance providers may have specific requirements for coverage of these tests, and healthcare providers should ensure that they are using the appropriate CPT code for the specific test being performed to ensure accurate billing and reimbursement. Additionally, healthcare providers should document the medical necessity of the test in the patient’s medical record.
4. CPT Codes for Bronchial Provocation Testing
Bronchial provocation testing is a type of pulmonary function test that is used to diagnose or monitor asthma and other respiratory conditions. This type of test involves exposing the patient to a substance that can cause the airways to constrict, such as methacholine or histamine. The patient’s lung function is then measured to evaluate how the airways are affected by the substance. The CPT codes for bronchial provocation testing include 95070 and 95071. These codes are used to bill for the testing procedure, and are based on the level of service provided. Code 95070 is used for the initial test, while code 95071 is used for subsequent tests.
5. CPT Codes for Pulmonary Stress Testing
Pulmonary stress testing is a type of pulmonary function testing (PFT) that evaluates how the lungs and heart respond to physical exertion. These tests can be useful in diagnosing and monitoring respiratory and cardiovascular conditions such as asthma, COPD, and heart disease. There are several CPT codes related to pulmonary stress testing. Here’s a breakdown of what each code represents:
- 96417: This code is used for pulmonary exercise testing (e.g., treadmill or bicycle ergometer) with continuous ECG monitoring.
- 96418: This code is used for pulmonary exercise testing with continuous ECG monitoring and continuous measurement of inspired and expired gas volumes and oxygen and carbon dioxide concentrations.
- 94619: This code is used for measurement of oxygen uptake during exercise (e.g., using a treadmill or bicycle ergometer) for the purpose of assessing oxygen consumption and cardiorespiratory status.
- 96421: This code is used for pulmonary exercise testing with measurement of oxygen uptake, carbon dioxide output, and minute ventilation.
6. Medicare’s Reasonable and Necessary Care Codes
Medicare’s standards of reasonable and necessary care refer to the criteria that must be met for a medical service to be covered by Medicare. In general, Medicare will only cover services that are deemed medically necessary and reasonable for the treatment of a patient’s condition. For PFTs, Medicare has specific requirements that must be met in order for the service to be considered reasonable and necessary. CPT codes relative to Medicare’s standards of reasonable and necessary care are: 94070, 94200, 94640, 94726, 94727 and 94729. Here’s a short description for each code:
- 94070: This code is used for spirometry, which measures how much air a patient can exhale and how quickly they can do so.
- 94200: This code is used for maximal voluntary ventilation (MVV) testing, which measures how much air a patient can inhale and exhale in one minute.
- 94640: This code is used for nebulizer treatment, which is a type of therapy that delivers medication directly to the lungs through a device called a nebulizer.
- 94726: This code is used for lung volume measurement, which measures the amount of air in the lungs at different points in the breathing cycle.
- 94727: This code is used for gas diffusion testing, which measures how well oxygen and carbon dioxide move between the lungs and the blood.
- 94729: This code is used for bronchial provocation testing, which is a type of test used to diagnose asthma and other respiratory conditions.
Healthcare providers should ensure that they are using the appropriate CPT code for the specific test being performed to ensure accurate billing and reimbursement. It’s important to note that healthcare providers should only order the specific pulmonary function tests that are clinically necessary for the patient’s condition. Routine or repetitive testing may not be considered clinically reasonable and may not be covered by insurance, including Medicare. Additionally, providers should document the medical necessity of the test in the patient’s medical record.
ICD-10 CM Codes for Pulmonary Function Tests
ICD-10-CM codes are used to describe medical diagnoses and conditions for billing and reimbursement purposes. While CPT codes are used to describe the specific tests and procedures performed during a patient encounter, ICD-10-CM codes are used to indicate the medical reason for the test or procedure. For pulmonary function tests (PFTs), there are several ICD-10-CM codes that may be used, depending on the specific condition being evaluated or monitored. There is no single comprehensive list of ICD-10-CM codes for pulmonary function tests (PFTs), as the specific codes used will depend on the individual patient’s medical condition and the reason for performing the test. However, following are some examples of ICD-10-CM codes that may be used for various respiratory conditions that may be evaluated or monitored through PFTs:
- 0: Simple chronic bronchitis
- 9: Emphysema, unspecified
- 0: Chronic obstructive pulmonary disease with acute lower respiratory infection
- 1: Chronic obstructive pulmonary disease with (acute) exacerbation
- 9: Chronic obstructive pulmonary disease, unspecified
- 909: Asthma, unspecified, uncomplicated
- 4: Chronic respiratory conditions due to chemical fumes and vapors
- 10: Idiopathic interstitial pneumonia, not otherwise specified
- 113: Idiopathic pulmonary fibrosis with fibrosis of the lung, unilateral
- 81: Exercise-induced bronchospasm
It’s important to note that the specific ICD-10-CM code used will depend on the individual patient’s medical condition and the reason for performing the PFT. Healthcare providers should work closely with their billing and coding staff to ensure that the appropriate codes are used for each patient encounter.
Conclusion
It’s important to note that different payers may have different requirements for coding for PFTs. Some payers may require additional codes or modifiers to indicate certain aspects of the test, such as the use of a bronchodilator. Therefore, it’s important to check with each individual payer to ensure compliance with their specific requirements. Billing for PFTs can be a complex process, but by following the proper coding and documentation requirements, providers can ensure that they receive proper reimbursement for these important diagnostic tests.
We hope that article has provided all basic information on coding for pulmonary function tests. Medisys Data Solutions is a medical billing company that specializes in pulmonary billing and coding. Our experienced billers and coders streamline the billing process for the clients while ensuring accuracy and compliance. With years of experience in pulmonary billing, we provide customized solutions to help our clients achieve their financial goals and maximize reimbursement for the services. By partnering with us, you can focus on providing high-quality care to their patients while leaving the billing and coding to the experts. To know more about our pulmonary billing and coding services, contact us at info@medisysdata.com / 888-720-8884
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