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New PFT codes for 2012

Lyzette Posted Tue 28th of February, 2012 21:55:11 PM

Can you please give me the valid combination codes for a full PFT so we can capture our charges correctly? Thanks

SuperCoder Answered Wed 29th of February, 2012 06:52:55 AM

The PFT is a diagnostic procedure that allows the physician to measure the functional status of the lungs. It is made up of the following: Spirometry, Lung Volume, Diffusion Capacity, Lung compliance and Pulmonary Studies during exercise testing.

PFT codes are ranged b/w 94010-94013. These are reported for measurements in infants and young children through 2 years of age. PFT measurements are reported as actual values and as a percent of predicted values by age, gender, height and race.

Exact coding will depend upon documentation and medical necessity.

The spirometry testing covers CPT codes 94010, 94375, and 94060. Each of these covers a different form of test and, of course, the amounts are different. Therefore, although you might be covering the right test, the CPT code makes the difference.

Lung Volume CPT codes 94240, CPT codes 94260, CPT codes 94360

Diffusion Capacity CPT code 94729

Lung Compliance CPT code 94750

Pulmonary Stress Testing CPT code 94620

SuperCoder Answered Wed 29th of February, 2012 06:59:04 AM

Frequently repeated tests have been denied payment by some carriers. Documentation can be submitted to justify the testing, eg, repeat of full PFT and Dlco during treatment of interstitial lung disease. CMS (Medicare) has frequency edits that are not published called Medically Unlikely Edits (MUE). These edits have been reviewed by the medical specialties. If you encounter an inappropriate denied payment, appeal with justification for the repeated PFTs.

94726 could be a code reported in case of full PFTs, but this opinion varies from coder to coder and based on documentation.

Deborah Answered Mon 26th of March, 2012 15:06:40 PM

I use 94010 and 94060 for spirometry and use a 26 modifier if just billing for the interpretation. Lung volumes is 94727 and again I use a 26 modifier if only billing for the interpretation. Diffusion capacity is 94729 and I use the 26 modifier. I have been getting paid for these codes from Medicare. But for some reason, Blue Cross will not pay for these codes when I use the 26 modifier. Is there a special code for the interpretation of LUng volumes and diffusion capacity that I do not know about. Can anyone help?

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