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interp pft Inpatient

Janice Posted Fri 14th of September, 2012 19:33:01 PM

hi im new to pulmonary can you give me the codes for a hospital pft interp
thanks

SuperCoder Answered Fri 14th of September, 2012 19:52:34 PM

PFTs measure the ability of the lungs to use air. The results help diagnose breathing problems.

Reimbursement is available for medically necessary PFTs. Spirometry ranks as the most common PFT. CPT codes describe the various PFTs, many of which are components of spirometry. Bill PFTs with the appropriate CPT code from the range
94010-94799. The most commonly billed PFTs codes include:

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

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

94070 -- prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics

94014 -- reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation

94015 -- recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration)

94016 -- physician review and interpretation only.

Codes 94014, 94015 and 94016 will be paid once in a 30-day period. Medicare reimburses initial hospital and office consults, initial hospital visits, and new-patient office visits, in addition to PFTs when performed on the same day. Medicare also reimburses follow-up or subsequent E/M services in addition to PFTs when the E/M service is for a significant, separately identifiable condition. Bill the PFTs appending modifier -25 to the appropriate E/M code.

Documentation must be in the clinical record to support the use of the E/M codes. If two or more spirometry codes are billed on the same date of service, Medicare will reimburse only one.

Bill a methacholine challenge test using code 95070 (inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine or similar compounds) when performed with spirometry. Medicare will not reimburse the administration of methacholine without spirometry.

Janice Posted Fri 14th of September, 2012 23:41:41 PM

so do i just put 26 modifiers on all th e codes??for an interp

Janice Posted Sun 16th of September, 2012 23:55:31 PM

sorry i meant which codes would i put a 26 on if my doctor did a pft interp in the hospital?? would it still be the same codes as in the office but with a 26??

SuperCoder Answered Mon 17th of September, 2012 21:33:23 PM

I will explain by giving you an example with 94010 and 94060

Because the pulmonary function test (PFT) codes that you mention contain both a professional and technical component, you can use modifiers 26 (Professional component) and TC (Technical component) to bill the appropriate portions of 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and 94060 (Bronchospasm responsiveness, spirometry as in 94010, pre- and postbronchodilator administration).

When you are not billing for the entire service (which includes the technical and professional portions), report the appropriate code with a modifier appended to describe the pulmonologist’s portion of the rendered service:

Scenario 1. To bill for the professional component only: When the test is provided in an outpatient hospital where the pulmonologist does not employ the staff or own the equipment, the only charge reported by the physician would be 94010 with modifier 26 (or 94060-26) appended to indicate the professional component. “The total relative value units (RVUs) for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense,” according to “Attachment A” of the 2006 National Physician Fee Schedule Relative Value File.

The facility bills 94010-TC (or 94060-TC). CMS states, “The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only.”

Scenario 2. To bill both components (the global service): When services are provided in an office setting, where the pulmonologist owns the equipment, 94010 (or 94060), which encompasses the TC and 26 portions, is reported. Be careful not to add a modifier. Why: The total RVUs for codes reported without a modifier include values for physician work, practice expense, and malpractice expense, CMS explains in the fee schedule attachment.

Janice Posted Tue 18th of September, 2012 11:45:30 AM

Thank-you so much for your answer but again i dont think you are answering my question.
i know what a 26 and global and tc are, My question was on the cpt code's i should be using.

Janice Posted Tue 18th of September, 2012 11:45:33 AM

Thank-you so much for your answer but again i dont think you are answering my question.
i know what a 26 and global and tc are, My question was on the cpt code's i should be using.

SuperCoder Answered Tue 18th of September, 2012 20:51:05 PM

CPT code 94060 (bronchospasm evaluation; spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) includes the following codes:

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

•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)

•94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation)

•94770 (carbon dioxide, expired gas determination by infrared analyzer )

Bill all other CPT codes for the pulmonary function test distinctly. Append modifier -26 if services are carried out in a hospital and your physician is giving a written interpretation and report.

Janice Posted Mon 24th of September, 2012 16:36:38 PM

Thanks so much

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