Coding and Billing Basics

Lung volumes measured by the use of plethysmography are coded 94726. If the plethysmography method is used to determine lung volume, it will include airway resistance testing. If lung volumes are measured using helium dilution or nitrogen washout procedures, the correct code will be 94727. This includes determination of the total lung capacity and all contributory lung volume determinations (residual volume and the functional residual capacity).

Impulse oscillometry (94728) is now defined as assessing airway resistance and may be reported in addition to gas dilution techniques (94727). Code 94728 is not to be reported in addition to a spirometry (94010), a pre- and post-spirometry with bronchodilator(94060),abronchospasmprovocation evaluation (94070), a flow-volume loop (94375) or a plethysmography (94726). Base spirometry (94010) and pre- and post-spirometry with bronchodilator (94060) are not included in the plethysmography code 94726. They also are not included in the gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes, code 94727.

Diffusing capacity (+94729) is now an add-on code. It is to be used in addition to the spirometric codes (94010, 94060) as well as the flow loop (94375) and the plethysmography and the gas dilution codes (94726-94729).

The pulmonary compliance study code (94750) is used to report a study that identifies and quantifies lung elastic properties. It requires that an esophageal catheter be placed to measure esophageal pressure, to reflect pleural pressure.

The pulmonary stresstest code (94620)isfor a simple pulmonary stresstest.It can be used for a “six-minute walk” or it may be used for multiple spirometries with exercise. Documentation and diagnoses will support the use of this code for a patient. The documentation must include more than oxygen levels in order to code for a simple pulmonary stress test.

Pressurized or nonpressurized inhalation treatment is coded with 94640. This is the appropriate code when a patient is in need of a nebulizer treatment for an acute airway obstruction and the treatment lasts less than one hour. The 94644 code is used for inhalation treatments lasting more than one hour, and 94645 is used for each additional hour after the first hour of inhalation treatment. Because codes 94644 and 94645 have a time component listed in the code, it is necessary to have time documented in the chart note to support the code.

Teaching patients to use their metered-dose inhalers, nebulizers or aerosol generators is coded with 94644. This code is bundled with 94060 because it is appropriate to teach the patient how to use the bronchodilator prior to use and prior to performing the second spirometry. The teaching code 94664 may be used in addition to an E/M code, and it may be reported one time per day per patient.

Pulse oximetry single determinations (94760) are included by many carriers as part of an E/M of service. The 94760 code is considered a vital sign for the patient. If multiple determinations are performed or if the patient has an overnight oximetry reading, these instances may be billable to the payer for coverage. The multiple determinations would be coded with 94761 and the overnight reading would be coded with 94762