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Family Practice Coding Alert

Understand Pulmonary Function Coding to Boost Payment for Spirometry

Many family practice coders describe significant confusion regarding how to properly report pulmonary function tests (PFT) performed in their physicians offices. At first glance, there are an overwhelming number of codes listed in the pulmonary portion of CPTs Medicine section. However, only a couple of these codes typically are used by a family physician.

Most family physicians will perform spirometry as described in codes 94010 and 94060, explains Cynthia DeVries, RN, CPC, coding and reimbursement specialist with Lee Physicians, a 140-physician practice in Fort Myers, Fla. CPT defines these two codes as:

94010 spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation; and

94060 branchospasm evaluation; spirometry as in 94010, before and after bronchodilator (aerosol or parenteral).

There are a variety of additional codes, but many are considered bundled into 94060 by the Correct Coding Initiative (CCI) including 94200 (maximum breathing capacity, maximal voluntary ventilation), 94375 (respiratory flow volume loop), 94640 (nonpressurized inhalation treatment for acute airway obstruction), 94650 (intermittent positive pressure breathing [IPPB] treatment, air or oxygen, with or without nebulized medication; initial demonstration and/or evaluation), and 94770 (carbon dioxide, expired gas determination by infrared analyzer). These component codes cannot be reported on the same date in addition to 94060.

Spirometry is a basic ventilation test within the battery of assessments included in pulmonary function testing, according to Cynthia Thompson, CPC, senior consultant at Gates, Moore & Co., a physician practice management and consulting firm in Atlanta. A family physician will most often use spirometry for preoperative testing, to evaluate lung disease, to appraise the effect another systemic disease has on pulmonary functions or to assess the effectiveness of a treatment, she says. During the study, a spirometer is used to measure tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume, inspiratory capacity and vital capacity.

Each measure is generally taken three times and an average result is calculated, Thompson explains. However, coders may bill only one unit of service for these measurements that are part of spirometry.

A bronchospasm evaluation differs in that spirometry is performed before and after a bronchodilator (a drug that relaxes the bronchial muscles) has been administered to the patient. While the same machine is used, the entire series of tests is often not needed. The test most often used is a peak flow, or an evaluation of how fast the patient can move air in and out of his or her lungs. Coders should note that when a bronchospasm evaluation is conducted, you would report only 94060, Thompson explains. Code 94010, describing spirometry services, is considered bundled into 94060 by both Medicare and CPT.

Some practices may not own a spirometer and [...]