Pulmonary function tests play a crucial role in assessing respiratory health and diagnosing pulmonary conditions. When it comes to coding these tests, the Current Procedural Terminology (CPT) provides comprehensive and component codes to accommodate the variations found in pulmonary function laboratories. In this article, we will explore the pulmonary coding guidelines to ensure accurate reporting and appropriate reimbursement.
Understanding Pulmonary Coding Guidelines
1. Reporting Alternative Methods of Data Calculation
During a spirometry or other pulmonary function session, it is important to note that alternate methods of reporting data should not be reported separately. For example, the flow volume loop, which is an alternative method of calculating a standard spirometric parameter, is included in the standard spirometry studies (rest and exercise) with CPT code 94375.
2. Reporting E&M Services
Physicians attending pulmonary diagnostic testing or therapy sessions should not report a separate Evaluation and Management (E&M) service if they only perform a limited history and physical examination related to the testing or therapy. However, if a significant and separately identifiable E&M service unrelated to the testing or therapy is provided, it may be reported with modifier 25.
3. Reporting Multiple Spirometric Determinations
When multiple spirometric determinations are required to complete a service described by a specific CPT code, only one unit of service should be reported. For instance, CPT code 94070 describes bronchospasm provocation with an administered agent and utilizes multiple spirometric determinations, similar to CPT code 94010. In such cases, a single unit of service includes all the necessary spirometric determinations.
4. Comprehensive Cardiopulmonary Exercise Testing
Comprehensive cardiopulmonary exercise testing with CPT code 94621 involves various component tests defined in the CPT Manual. It is important to note that reporting component services such as venous access, ECG monitoring, spirometric parameters performed before, during, and after exercise, oximetry, O2 consumption, CO2 production, and rebreathing cardiac output calculations during the same patient encounter as a cardiopulmonary exercise test is inappropriate. Furthermore, reporting a cardiac stress test or a pulmonary stress test (CPT code 94618) or any components of these stress tests during the same patient encounter as a cardiopulmonary exercise test is also not allowed.
5. Ventilation Management and E&M Services
Under the NCCI (National Correct Coding Initiative) program, ventilation management CPT codes (94002-94004 and 94660-94662) should not be reported separately with E&M CPT codes. If both an E&M code and a ventilation management code are reported, only the E&M code will be payable.
6. Continuous Inhalation Treatment with Aerosol Medication
CPT code 94644, which describes continuous inhalation treatment with aerosol medication for acute airway obstruction (first hour), does not include physician work RVUs (Relative Value Units). When this procedure is performed in a facility, the physician does not have any practice expenses related to the procedure, as it utilizes facility staff and supplies. Therefore, physicians shall not report this code when ordering it in a facility. Additionally, this code should not be reported with certain other CPT codes unless the physician supervises the performance of the procedure at a separate patient encounter on the same date of service outside the facility where the physician has practice expenses related to the procedure.
7. Bronchodilation Responsiveness and Inhalation Treatment
CPT code 94060, which covers bronchodilation responsiveness with pre- and post-bronchodilator administration, is a diagnostic test used to assess patient symptoms related to reversible airway obstruction. It is essential to understand that this code does not describe the treatment of acute airway obstruction. Reporting CPT code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction) for the administration of the bronchodilator included in CPT code 94060 is considered misuse. However, the bronchodilator medication may be reported separately.
8. Inhalation Treatment for Acute Airway Obstruction
CPT code 94640 describes the treatment of acute airway obstruction with inhaled medication or the use of inhalation treatment to induce sputum for diagnostic purposes. It is important to note that CPT code 94640 should only be reported once during an episode of care, regardless of the number of separate inhalation treatments administered. Reporting spirometry measurements separately before and/or after the treatment(s) is not appropriate. Additionally, reporting CPT code 94060 in addition to CPT code 94640 is considered misuse. The inhaled medication, however, may be reported separately. An episode of care begins when a patient arrives at a facility for treatment and ends when the patient leaves the facility.
If the episode of care lasts more than one calendar day, only one unit of service of CPT code 94640 may be reported for the entire episode of care. If a patient receives inhalation treatment during an episode of care and returns to the facility for a second episode of care with inhalation treatment on the same date of service, the inhalation treatment during the second episode of care may be reported with modifier 76 appended to CPT code 94640. In cases where inhalation drugs are administered in a continuous treatment or a series of “back-to-back” continuous treatments exceeding one hour, CPT codes 94644 and 94645 may be reported instead of CPT code 94640.
9. Inhalation Treatment and Demonstration/Evaluation
CPT code 94640 and CPT code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator) generally should not be reported for the same patient encounter. The demonstration and/or evaluation described by CPT code 94664 is included in CPT code 94640 if the same device, such as an aerosol generator, is used in both procedures. However, if these services are performed at separate patient encounters on the same date of service, they may be reported separately.
10. espiratory Testing in Ventilation Management and Critical Care
Practitioner ventilation management (CPT codes 94002-94005, 94660, 94662) and critical care (CPT codes 99291, 99292, 99466-99486) encompass respiratory flow volume loop (CPT code 94375), breathing response to carbon dioxide (CPT code 94400), and breathing response to hypoxia (CPT code 94450) testing if performed. It is important to note that CPT code 94400 was deleted on January 1, 2021.
Understanding the pulmonary coding guidelines is crucial to ensure accurate reporting and appropriate reimbursement. By adhering to these guidelines, healthcare providers can streamline their coding practices and improve the efficiency of pulmonary function testing and therapy.
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Reference: CMS National Correct Coding Policy Manual, Chapter 11
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