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New to billing for pulmonology.. re: 94729;

Denise Posted Thu 14th of June, 2012 19:05:05 PM

How do I know when I can bill this with a 94010 or 94060..what wording
identifies the 94729 was performed? Also, do I use a 59 or 51 modifier on the 94729?

SuperCoder Answered Thu 14th of June, 2012 19:19:35 PM

Take a look at this procedure scenario to help you understand how the measure of DLCO is performed:

"The patient was asked to be seated in a comfortable position. He was asked to exhale to a maximal extent such that it reached residual volume levels following which he was quickly asked to inhale a mixture of air, 0.3% carbon monoxide and a tracer gas of 5% helium. The patient was then instructed to hold his breath for about 10 seconds and then asked to exhale rapidly. The first 1000 ml of exhaled air was disposed and the rest was collected and used for analysis.

DLCO was measured by analyzing and measuring the exhaled air for calculating the concentration of carbon monoxide and tracer gas. To ensure that all the carbon monoxide is cleared, the procedure was then repeated at 5 minute intervals till the DLCO measurements between two subsequent procedures differed by 3ml/min/mm Hg."

Membrane diffusion capacity will involve two DLCO measurements. The first DLCO measurement will be similar to the example described above. Following the first procedure, the patient will then be asked to inhale highly concentrated oxygen for a period of 5 minutes following which the second DLCO measurement is performed. Using these two results, the DMCO is calculated using an appropriate formula.

It was earlier very difficult for coders to differentiate between the two procedures and report the correct one, as prior to the CPT® 2012 change these were to be reported with separate codes. Both involved multiple DLCO measurements differentiated by the type of gases used throughout the testing. However, the CPT® 2012 change should make it easy for you to report either of the procedures as you need to use only +94729. Under most circumstances, you can only report one unit of the code per day.

This CPT® 2012 change has made the task easier as there is no need to go into the procedure details to understand whether it is a test for carbon monoxide diffusing capacity or membrane diffusion capacity. Both are now reported with +94729.

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