Coding For Pulmonary Function Tests

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Coding For Pulmonary
Function Tests
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Coding For Pulmonary Function Tests
Coding for pulmonary function tests (PFTs) is an
important aspect of healthcare billing and
reimbursement. These tests are used to evaluate
lung function and can be useful in diagnosing and
monitoring respiratory conditions such as asthma,
COPD, and pulmonary fibrosis. There are several
different types of PFTs, each with its own
specific set of CPT codes that healthcare
providers must use for billing purposes.
Understanding the correct codes to use for each
type of test is essential for accurate billing
and reimbursement, as well as for ensuring that
patients receive the appropriate care for their
respiratory conditions. In this article, we will
explore the various types of PFTs and the CPT and
diagnosis codes associated with them. Coding for
Pulmonary Function Tests CPT Codes for Pulmonary
Function Tests Pulmonary function tests (PFTs)
are used to evaluate lung function and diagnose
or monitor respiratory conditions. There are
several types of PFTs, including spirometry, lung
volume determination, diffusion capacity testing,
bronchial provocation testing, and pulmonary
stress testing. Each type of test has its own set
of Current Procedural Terminology (CPT) codes,
which healthcare providers and their billing and
coding staff must use in order to ensure accurate
billing and reimbursement. Pulmonary function
tests and applicable CPT codes are as follows
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Coding For Pulmonary Function Tests

• 1. CPT Codes for Spirometry Test
• Spirometry is a type of pulmonary function test
  (PFT) that measures how much air a person can
  exhale and how quickly they can do so. Its a
  common test used to diagnose and monitor
  respiratory conditions such as asthma, chronic
  obstructive pulmonary disease (COPD), and lung
  fibrosis. There are several CPT codes related to
  spirometry, which healthcare providers use to
  bill for this service. Heres a breakdown of what
  each code represents
• 94010 This code is used for a basic spirometry
  test, which measures how much air a patient can
  exhale in one breath.
• 94011 This code is used for a prolonged
  spirometry test, which measures how much air a
  patient can exhale over a longer period of time.
• 94012 This code is used for a spirometry test
  with a bronchodilator, which measures how much
  air a patient can exhale before and after using a
  medication that opens up the airways.
• 94060 This code is used for a spirometry test
  with a pre- and post-bronchodilator, which
  measures how much air a patient can exhale before
  and after using a bronchodilator medication.
• 94070 This code is used for a spirometry test
  with a bronchial challenge, which measures how
  the airways respond to a substance that may
  trigger asthma symptoms.
• 94150 This code is used for a comprehensive
  respiratory assessment, which may include
  spirometry as well as other tests to evaluate
  lung function.
• 94200 This code is used for maximal voluntary
  ventilation (MVV) testing, which measures how
  much air a patient can inhale and exhale in one
  minute.

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Coding For Pulmonary Function Tests

• 94375 This code is used for a capnography test,
  which measures the amount of carbon dioxide a
  patient exhales.
• 94726 This code is used for lung volume
  measurement, which measures the amount of air in
  the lungs at different points in the breathing
  cycle.
• 94727 This code is used for gas diffusion
  testing, which measures how well oxygen and
  carbon dioxide move between the lungs and the
  blood.
• 2. CPT Codes for Lung Volume Test
• Lung volume determination is a type of pulmonary
  function testing (PFT) that measures the amount
  of air in the lungs at different points in the
  breathing cycle. This type of testing can be
  useful in diagnosing and monitoring respiratory
  conditions such as chronic obstructive pulmonary
  disease (COPD), emphysema, and interstitial lung
  disease. There are several CPT codes related to
  lung volume determination. Heres a breakdown of
  what each code represents
• 94013 This code is used for multiple-breath
  helium dilution or nitrogen washout testing,
  which is a type of lung volume determination
  test.
• 94726 This code is used for plethysmography,
  which is a type of lung volume determination test
  that measures the amount of air in the lungs at
  the end of a full inhalation.
• 94727 This code is used for gas diffusion
  testing, which measures how well oxygen and
  carbon dioxide move between the lungs and the
  blood. While this test is not specifically a lung
  volume determination test, it is often performed
  along with other PFTs to provide a more complete
  picture of lung function.

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Coding For Pulmonary Function Tests

• 94728 This code is used for pressure-volume
  loops, which is a more complex type of lung
  volume determination test that is typically used
  in research settings.
• 3. CPT Codes for Diffusion Capacity Test
• Diffusion capacity is a type of pulmonary
  function testing (PFT) that measures how well
  oxygen and carbon dioxide move between the lungs
  and the blood. This type of testing can be useful
  in diagnosing and monitoring respiratory
  conditions such as pulmonary fibrosis, emphysema,
  and pulmonary hypertension. The CPT code for
  diffusion capacity testing is 94729. This code is
  used for single-breath carbon monoxide diffusing
  capacity (DLCO) testing, which is the most
  commonly used method for measuring diffusion
  capacity.
• During a DLCO test, the patient inhales a small
  amount of carbon monoxide and holds their breath
  for a short period of time before exhaling. The
  amount of carbon monoxide that is absorbed by the
  lungs is then measured, along with the amount of
  air that the patient breathed in and out during
  the test. This information is used to calculate
  the diffusion capacity of the lungs.
• Its important to note that healthcare providers
  should only order DLCO testing that is clinically
  necessary for the patients condition. Medicare
  and other insurance providers may have specific
  requirements for coverage of these tests, and
  healthcare providers should ensure that they are
  using the appropriate CPT code for the specific
  test being performed to ensure accurate billing
  and reimbursement.

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Coding For Pulmonary Function Tests

• Additionally, healthcare providers should
  document the medical necessity of the test in the
  patients medical record.
• 4. CPT Codes for Bronchial Provocation Testing
• Bronchial provocation testing is a type of
  pulmonary function test that is used to diagnose
  or monitor asthma and other respiratory
  conditions. This type of test involves exposing
  the patient to a substance that can cause the
  airways to constrict, such as methacholine or
  histamine. The patients lung function is then
  measured to evaluate how the airways are affected
  by the substance. The CPT codes for bronchial
  provocation testing include 95070 and 95071.
  These codes are used to bill for the testing
  procedure, and are based on the level of service
  provided. Code 95070 is used for the initial
  test, while code 95071 is used for subsequent
  tests.
• 5. CPT Codes for Pulmonary Stress Testing
• Pulmonary stress testing is a type of pulmonary
  function testing (PFT) that evaluates how the
  lungs and heart respond to physical exertion.
  These tests can be useful in diagnosing and
  monitoring respiratory and cardiovascular
  conditions such as asthma, COPD, and heart
  disease. There are several CPT codes related to
  pulmonary stress testing. Heres a breakdown of
  what each code represents
• 96417 This code is used for pulmonary exercise
  testing (e.g., treadmill or bicycle ergometer)
  with continuous ECG monitoring.
• 96418 This code is used for pulmonary exercise
  testing with continuous ECG monitoring and
  continuous measurement of inspired and expired
  gas volumes and oxygen and carbon dioxide
  concentrations.

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Coding For Pulmonary Function Tests

• 94619 This code is used for measurement of
  oxygen uptake during exercise (e.g., using a
  treadmill or bicycle ergometer) for the purpose
  of assessing oxygen consumption and
  cardiorespiratory status.
• 96421 This code is used for pulmonary exercise
  testing with measurement of oxygen uptake, carbon
  dioxide output, and minute ventilation.
• 6. Medicares Reasonable and Necessary Care Codes
• Medicares standards of reasonable and necessary
  care refer to the criteria that must be met for a
  medical service to be covered by Medicare. In
  general, Medicare will only cover services that
  are deemed medically necessary and reasonable for
  the treatment of a patients condition. For PFTs,
  Medicare has specific requirements that must be
  met in order for the service to be considered
  reasonable and necessary. CPT codes relative to
  Medicares standards of reasonable and necessary
  care are 94070, 94200, 94640, 94726, 94727 and
  94729. Heres a short description for each code
• 94070 This code is used for spirometry, which
  measures how much air a patient can exhale and
  how quickly they can do so.
• 94200 This code is used for maximal voluntary
  ventilation (MVV) testing, which measures how
  much air a patient can inhale and exhale in one
  minute.
• 94640 This code is used for nebulizer treatment,
  which is a type of therapy that delivers
  medication directly to the lungs through a device
  called a nebulizer.
• 94726 This code is used for lung volume
  measurement, which measures the amount of air in
  the lungs at different points in the breathing
  cycle.

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Coding For Pulmonary Function Tests

• 94727 This code is used for gas diffusion
  testing, which measures how well oxygen and
  carbon dioxide move between the lungs and the
  blood.
• 94729 This code is used for bronchial
  provocation testing, which is a type of test used
  to diagnose asthma and other respiratory
  conditions.
• Healthcare providers should ensure that they are
  using the appropriate CPT code for the specific
  test being performed to ensure accurate billing
  and reimbursement. Its important to note that
  healthcare providers should only order the
  specific pulmonary function tests that are
  clinically necessary for the patients condition.
  Routine or repetitive testing may not be
  considered clinically reasonable and may not be
  covered by insurance, including Medicare.
  Additionally, providers should document the
  medical necessity of the test in the patients
  medical record.
• ICD-10 CM Codes for Pulmonary Function Tests
• ICD-10-CM codes are used to describe medical
  diagnoses and conditions for billing and
  reimbursement purposes. While CPT codes are used
  to describe the specific tests and procedures
  performed during a patient encounter, ICD-10-CM
  codes are used to indicate the medical reason for
  the test or procedure. For pulmonary function
  tests (PFTs), there are several ICD-10-CM codes
  that may be used, depending on the specific
  condition being evaluated or monitored. There is
  no single comprehensive list of ICD-10-CM codes
  for pulmonary function tests (PFTs), as the
  specific codes used will depend on the individual
  patients medical condition and the reason for
  performing the test. However, following are some
  examples of ICD-10-CM codes that may be used for
  various respiratory conditions that may be
  evaluated or monitored through PFTs

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Coding For Pulmonary Function Tests

• 0 Simple chronic bronchitis
• 9 Emphysema, unspecified
• 0 Chronic obstructive pulmonary disease with
  acute lower respiratory infection
• 1 Chronic obstructive pulmonary disease with
  (acute) exacerbation
• 9 Chronic obstructive pulmonary disease,
  unspecified
• 909 Asthma, unspecified, uncomplicated
• 4 Chronic respiratory conditions due to chemical
  fumes and vapors
• 10 Idiopathic interstitial pneumonia, not
  otherwise specified
• 113 Idiopathic pulmonary fibrosis with fibrosis
  of the lung, unilateral
• 81 Exercise-induced bronchospasm
• Its important to note that the specific
  ICD-10-CM code used will depend on the individual
  patients medical condition and the reason for
  performing the PFT. Healthcare providers should
  work closely with their billing and coding staff
  to ensure that the appropriate codes are used for
  each patient encounter.
• Conclusion
• Its important to note that different payers may
  have different requirements for coding for PFTs.
  Some payers may require additional codes or
  modifiers to indicate certain aspects of the
  test, such as the use of a bronchodilator.
  Therefore, its important to check with each
  individual payer to ensure compliance with their
  specific requirements.

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Coding For Pulmonary Function Tests
Billing for PFTs can be a complex process, but by
following the proper coding and documentation
requirements, providers can ensure that they
receive proper reimbursement for these important
diagnostic tests. We hope that article has
provided all basic information on coding for
pulmonary function tests. Medisys Data Solutions
is a medical billing company that specializes in
pulmonary billing and coding. Our experienced
billers and coders streamline the billing process
for the clients while ensuring accuracy and
compliance. With years of experience in pulmonary
billing, we provide customized solutions to help
our clients achieve their financial goals and
maximize reimbursement for the services. By
partnering with us, you can focus on providing
high-quality care to their patients while leaving
the billing and coding to the experts. To know
more about our pulmonary billing and coding
services, contact us at info_at_medisysdata.com /
888-720-8884
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