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.
