Pulmonary Diagnostic Testing and Therapies (PFT) Codes.

As of the 2014 edition of the AMA’s CPT coding book, included under the subheading for the pulmonary function codes are directions for the provider that note that separate and identifiable E/M service should be reported in addition to the pulmonary function code. This will require the provider to use the 25 modifier on the E/M code when both services are provided.

The subsection heading also directs the provider as to when certain pulmonary function codes may be charged together and which pulmonary function codes are to be billed separately. The measurement of vital capacity (94150) is only billable when performed alone and is not a component of any other pulmonary function code. The vital capacity test (94150) represents the total volume of air a patient can expel during a slow full exhalation. It is used alone, for example, for monitoring neuromuscular diseases such as myasthenia gravis.

Spirometry (94010) is considered the basic foundation of pulmonary function testing. The patient’s forced exhalation is a volume of air plotted with respect to time. With many types of equipment, the flow-volume curve can be determined as well. The flow-volume curve (94375) graphs the airflow vs. lung volume as the patient performs forced expiration and forced inspiration maneuvers. The CPT subsection instruction now bundles 94010 and 94375 together, and allows only one of the two codes to be charged for both services when both services are performed during the same encounter. The subsection instruction also directs us to include the maximal breathing capacity code (94200) into a 94010 also.

The 94060 code is used for spirometry with a bronchodilator. The bronchodilator is included in the value of the code; only if the medication is purchased can medication be charged with a J code. You are not allowed to charge for administration of the bronchodilator. The subsection instructions of the CPT code book also direct allergists to include in the 94060 the flow-volume loop (94375) and the maximal breathing capacity (94200) when these services are performed before and after spirometry with a bronchodilator (94060).

The maximum voluntary ventilation (MVV; 94200) is a measurement in which the patient breathes as rapidly as possible for 10 seconds while total volume of air movement is measured. MVV often is included as part of simple PFT with spirometry, before and after bronchodilation or flow-volume curve. The 94200 code is bundled with 94010 and 94060. Codes 94200 and 94375 may be reported if they are the only tests provided during a session. Both tests need to have separate documentation of interpretations.

The bronchospasm provocation evaluation code (94070) is most commonly used for the pulmonary function portion of a methacholine challenge test. It also could be used for determination of multiple spirometries. Provocation evaluation coding requires a combination of two codes: 94070 for the multiple spirometric determinations, and 95070 for the administering of the bronchial inhalation agent. If you are performing a methacholine challenge, you would use the J7674 code for the methacholine. This would be charged per milligrams used during the testing.  

Expired gas collection, quantitative,single procedure (94250)(separate procedure) appliesto the collection and the reporting of the evaluation of expired air. This is reportable only when it is performed as a single procedure without any other pulmonary function testing.