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Pulmonology Coding Alert

You Be the Coder: Medicare Covers PFT Technical Component -- But With Limitations


- Published on Wed, Nov 30, 2011

Question:

My claim implies pulmonary function test without physician interpretation. Will Medicare still pay for the service?

Wisconsin Subscriber

Answer:

Pulmonary function test (PFT) claims without interpretation is acceptable for Medicare -- as long as you're billing services with modifier TC (Technical component). However, be sure to accomplish physician interpretation (by a member of your group, or via arrangement with another physician group) within a reasonable amount of time (i.e., 48 to 72 hours) to ensure that clinical and quality of care guidelines are met.

Tip: Don't forget that when component coding occurs for PFTs, the location of the testing plays a part in how you code these tests.

Example: A technologist in an outpatient hospital PFT lab performs respiratory flow volume test (94375, Respiratory flow volume loop). The lab should report 94375 appended by modifier TC to describe the technical component of the service. On the other hand, the physician who will provide the interpretation [...]

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