Ace your Pulmonary Function Testing Claims

 CPT code for pulmonary function testing

Read answers to these two expert medical billing and coding questions and know the accurate CPT codes for pulmonary function testing.

Question: Your practice is interested in carrying out pulmonary function testing on asthma patients. How would you bill? 94010? 94016? Can you also charge a copayment? Is it worth buying a spirometry device?

Answer: CPT code for pulmonary function testing is essentially 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation). A lot of many physicians consider they can bill 94010 for a hand held peak-flow meter, which has no code and is not distinctly billable.

You should not code 94016 (patient-initiated spirometric recording per 30-day period of time; physician review and interpretation only) lest the patient had a spirometer at home. The key to coding 94016 is carrying out the interpretation, whether you get reports over the phone lines from a rented machine in the patients home, or the patient brings printouts in.

The other CPT code for pulmonary function testing is 94060 (bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). You should not use 94060 and 94010 on the same day. The bronchodilation is included in the 94060; do not bill for it distinctly.

Both 94060 and 94010 need a spirometer with a mechanism that shows results graphically. Whether it is worth buying one depends on the total asthma patients you have. A lot of pediatricians treat asthma without a spirometer; however, pediatricians who specialize in asthma and allergy could not get by without one. Primary care pediatricians should know that its not at all times easy to get good spirometry on younger children

Question: You have the CPT codes for the pulmonary function test (PFT) interpretations. However you are required to know if for a whole PFT study there is one code to bill with the modifier -26 (professional component), or should you bill for each procedure? For instance, in case a patient has complete PFTs (e.g., carbon monoxide diffusion capacity, and spirometry with bronchodilation, plethysmographic method), is there a particular code for the complete reading?

Answer: CPT code 94060 (bronchospasm evaluation; spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]) includes the following codes:

• 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation)
• 94200 (maximum breathing capacity, maximal voluntary ventilation)
• 94375 (respiratory flow volume loop)
• 94640 (nonpressurized inhalation treatment for acute airway obstruction)
• 94650 (intermittent positive pressure breathing IPPB) treatment, air or oxygen, with or without nebulized medication; initial demonstration and/or evaluation)
• 94664 (aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum induction for diagnostic purposes; initial demonstration and/or evaluation)
• 94770 (carbon dioxide, expired gas determination by infrared analyzer )

Bill all other CPT codes for the pulmonary function test distinctly. Append modifier -26 if services are carried out in a hospital and your physician is giving a written interpretation and report.

CPT Deleted and New Codes in 2014 for Cardiology

2013 CPT® Description	2014 CPT® Description
	•0580F -Multidisciplinary care plan developed or updated (ALS)
	•0581F -Patient transferred directly from anesthetizing location to critical care unit (Peri2)
	•0582F -Patient not transferred directly from anesthetizing location to critical care unit (Peri2)
	•0583F -Transfer of care checklist used (Peri2)
	•0584F -Transfer of care checklist not used (Peri2)
	▲1040F – DSM IV™ criteria for major depressive disorder documented at the initial evaluation (MDD, MDD ADOL)1
	•1500F -Symptoms and signs of distal symmetric polyneuropathy, reviewed and documented (DSP)
	•1501F -Not initial evaluation for condition (DSP)
	•1502F -Patient queried about pain and pain interferences with function using a valid and reliable instrument (DSP)
	•1503F -Patient queried about symptoms of respiratory insufficiency (ALS)
	•1504F -Patient has respiratory insufficiency (ALS)
	•1505F Patient does not have respiratory insufficiency
	•3751F – Electrodiagnostic studies for distal symmetric polyneuropathy conducted (or requested), documented, and reviewed within 6 months of initial evaluation for condition (DSP)
	•3752F -Electrodiagnostic studies for distal symmetric polyneuropathy not conducted (or requested), documented, or reviewed within 6 months of initial evaluation for condition (DSP)
	•3753F -Patient has clear clinical symptoms and signs that are highly suggestive of neuropathy AND cannot be attributed to another condition, AND has an obvious cause for the neuropathy (DSP)
	•3754F -Screening tests for diabetes mellitus reviewed, requested, or ordered (DSP)
	•3755F -Cognitive and behavioral impairment screening performed (ALS)
	•3756F- Patient has pseudobulbar affect, sialorrhea, or ALS-related symptoms (ALS)
	•3757F -Patient does not have pseudobulbar affect, sialorrhea, or ALS-related symptoms (ALS)
	•3758F – Patient referred for pulmonary function testing or peak cough expiratory flow (ALS)
	•3759F -Patient screened for dysphagia, weight loss, or impaired nutrition (ALS)
	•3760F -Patient exhibits dysphagia, weight loss, or impaired nutrition (ALS)
	•3761F -Patient does not exhibit dysphagia, weight loss, or impaired nutrition (ALS)
	•3762F -Patient is dysarthric (ALS)
	•3763F -Patient is not dysarthric (ALS)
	•4540F -Disease modifying pharmacotherapy discussed (ALS)
	•4541F -Patient offered treatment for pseudobulbar affect, sialorrhea, or ALS-related symptoms (ALS)
	•4550F – Options for noninvasive respiratory support discussed with patient (ALS)
	•4551F -Nutritional support offered (ALS)
	•4552F -Patient offered referral to a speech language pathologist (ALS)”
	•4553F -Patient offered assistance in planning for end of life issues (ALS)”
	•4554F -Patient received inhalational anesthetic agent (Peri2)”
	•4555F -Patient did not receive inhalational anesthetic agent (Peri2)”
	•4556F -Patient exhibits 3 or more risk factors for post-operative nausea and vomiting (Peri2)”
	•4557F -Patient does not exhibit 3 or more risk factors for post-operative nausea and vomiting (Peri2)”
	•4558F -Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and intraoperatively (Peri2)
	•4559F -At least 1 body temperature measurement equal to or greater than 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (Peri2)
	•4560F -Antesthesia technique did not involve general or neuraxial anesthesia (Peri2)
	•4561F -Patient has a coronary artery stent (Peri2)
	•4562F – Patient does not have a coronary artery stent (Peri2)
	•4563F – Patient received aspirin within 24 hours prior to anesthesia start time (Peri2)
	•9001F-Aortic aneurysm less than 5.0 cm maximum diameter on centerline formatted CT or minor diameter on axial formatted CT (NMA-No Measure Associated)
	•9002F-Aortic aneurysm less than 5.0 – 5.4 cm maximum diameter on centerline formatted CT or minor diameter on axial formatted CT (NMA-No Measure Associated)
	•9003F-Aortic aneurysm less than 5.5 – 5.9 cm maximum diameter on centerline formatted CT or minor diameter on axial formatted CT (NMA-No Measure Associated)
	•9004F-Aortic aneurysm less than 6.0 cm or greater maximum diameter on centerline formatted CT or minor diameter on axial formatted CT (NMA-No Measure Associated)
	•9005F-Asyptomatic carotid stenosis: No history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory (NMA – No Measure Associated)
	•9006F-Symptomatic carotid stenosis: Ipsilateral carotid territory TIA or stroke less than 120 days prior to procedure (NMA-No Measure Associated)
	•9006F-Other carotid stenosis: Ipsilateral TIA or stroke 120 days or greater prior to procedure or any prior contralateral carotid territory or vertebrobasilar TIA or stroke (NMA-No Measure Associated)
0078T -Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm for dissection, abdominal aorta involving visceral branches, superior mesenteric, celiac and/or renal artery(s)	0078T -Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm for dissection, abdominal aorta involving visceral branches, superior mesenteric, celiac and/or renal artery(s)
0079T -Placement of visceral extension prosthesis for endovascular repair of endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch	0079T -Placement of visceral extension prosthesis for endovascular repair of endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch
0080T -Endovascular repair using prosthetics of abdominal aorta aneurysm, pseudoaneurysm/dissection abdominal aorta involving visceral vessels, , superior mesenteric, celiac and/or renal artery(s), radiologic supervision and interpretation	0080T -Endovascular repair using prosthetics of abdominal aorta aneurysm, pseudoaneurysm/dissection abdominal aorta involving visceral vessels, , superior mesenteric, celiac and/or renal artery(s), radiologic supervision and interpretation
0081T -Placement o visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch, radiological supervision and interpretation	0081T -Placement o visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch, radiological supervision and interpretation
0124T -Conjunctival incision with posterior extrascleral placement of pharmacological agent (does not include supply of medication)	0124T -Conjunctival incision with posterior extrascleral placement of pharmacological agent (does not include supply of medication)
0183T -Low frequency, non-contact, non-thermal ultrasound, including topical allicatin(s), when performed wound assessment, and instruction(s) for ongoing care, per day	0183T -Low frequency, non-contact, non-thermal ultrasound, including topical allicatin(s), when performed wound assessment, and instruction(s) for ongoing care, per day
0185T -Multivariate analysis patient specific finding with quanfiable complex  problem assessment, including report	0185T- Multivariate analysis patient specific finding with quanfiable complex  problem assessment, including report
0186T – Suprachoroidal delivery of pharmacologic agent (does not include supply of medication)	0186T - Suprachoroidal delivery of pharnacologic agent (does not include supply of medication);
0192T – External approach	0192T - External approach
0260T -Total body system hypo, day, neonate less than <= 28 days	0260T -Total body system hypo, day, neonate less than <= 28 days
0261T –Selective head hypothermia, per day, in the neonate 28 days of age or younger	0261T-Selective head hypothermia, per day, in the neonate, 28 days of age or younger
0318T – Implantation of catheter delivered prosthetic aortic heart valve, open thoracic approach, (e.g., transapical, other than transaortic);	0318T Implantation of catheter-delivered prosthetic aortic heart valve, open thoracic approach, (e.g., transapical, other than transaortic);
	•0320T – Insertion of subcutaneous defibrillator electrode
	•0321T  - Insertion of subcutaneous implantable defibrillator pulse generator only with existing subcutaneous electrode
	•0322T – Removal of subcutaneous implantable defibrillator pulse generator only
	•0323T – Removal of subcutaneous implantable defibrillator pulse generator with replacement of subcutaneous implantable defibrillator pulse generator only
	•0324T – Removal of subcutaneous defibrillator electrode
	•0325T – Repositioning of subcutaneous implantable defibrillator electrode and/or pulse generator
	•0326T - Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters
	•0327T – Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable subcutaneous lead defibrillator system
	•0328T – Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, implantable subcutaneous lead defibrillator system
	•0329T - Monitoring of intraocular pressure for 24 hours or longer, unilateral or bilateral, with interpretation and report
	•0330T – Tear film imaging, unilateral or bilateral, with interpretation and report
	•0331T – Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment;
	•0332T – with tomographic SPECT
	•0333T – Visual evoked potential, screening of visual acuity, automated
	•0334T – Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic)
	•⦿0335T - Extra-osseous subtalar joint implant for talotarsal stabilization
	•0336T - Laparoscopy, surgical, ablation of uterine (fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency
	•0337T - Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (e.g., brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral
	•0338T - Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast Injection (s), intraprocedural roadmapping and and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral
	•0339T -     bilateral

ICD 9 code for decreasing ejection fraction

Do you know Which ICD-9 code  you should use for abnormal ejection fraction?

Echocardiography is the most common way to measure ejection fraction. If ejection fraction is abnormal then the findings should be stated as abnormal.
would at least go with 794.39 : Other nonspecific abnormal function study of cardiovascular system 

When should the charge for ultrasound biometry

When should the charge for ultrasound biometry with IOL calculations be submitted to insurance: on the day it is done and interpreted, or on the day the cataract surgery is performed?


Answer: In most Medicare carrier areas, the A-scan can be billed when it is performed; you do not have to wait until the cataract surgery. A few Medicare carriers still require that the date of surgery be entered on the claim in the note or comment field when billing for this procedure, but most do not. Check with your Medicare carrier for any unique claim filing requirements they may have.

HCFA policy even allows the A-scan to be billed for both eyes at the same time when both cataracts will be operated on within a short time frame. This is why most Medicare carriers no longer require the A-scan to be billed on the day of surgery.

Answers contributed by Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; and Michael X. Repka, MD, American Academy of Ophthalmology representative to the CPT Advisory Committee.

NCCI 11.3 Update: Include Duct Probe in Dacryocystorhinostomy

The latest bundles also clarify the rules for IOL exchanges
You probably won’t tear up when you see what NCCI is up to this quarter--unless your practice spends a fair share of its time performing nasolacrimal probes.

NCCI version 11.3, that took effect Oct. 1, specifies that CPT codes 68810 (Probing of nasolacrimal duct, with or without irrigation) and 68811 (… requiring general anesthesia) are included in:

• 31239--Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy

• 68530--Removal of foreign body or dacryolith, lacrimal passages

• 68720--Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity).


Translation: You can no longer report 68810 or 68811 along with those three codes unless it is a separate procedure, marked with modifier 59 (Distinct procedural service).

Additionally, NCCI has determined that 68840 (Probing of lacrimal canaliculi, with or without irrigation) is included in 68530 and 68700 (Plastic repair of canaliculi).

NCCI 11.3 also addresses IOL insertions and exchanges. IOL insertion procedure 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) includes 65920 (Removal of implanted material, anterior segment of eye) as a component, so you should not report those two codes together unless you can justify appending modifier 59. Code 66986 (Exchange of intraocular lens) now also includes 66985, since NCCI identifies 66986 as a “more extensive” procedure.

Removal of implanted material (65920) is already bundled into IOL exchanges (66986), says Christina Hollis, OCS, coder and surgery scheduler at Pediatric Ophthalmology Associates in Columbus, Ohio.

Bottom line: Don’t attempt to report an IOL exchange by using both 66985 and 65920. The NCCI edits have assigned a bundling modifier “1” to these codes, so unless there is evidence of a separate anatomical site (separate eye), reporting these procedures together is prohibited. If the ophthalmologist both removes an old IOL and inserts a new IOL, report 66986, which specifically describes IOL exchanges.

Coding 65920 with 66986 is inappropriate “because the removal of the IOL is an integral part of an IOL exchange,” Hollis says. “You’d basically be paid twice for removing the IOL. The same reasoning applies to 66985 and 66986--you’d be paid twice for inserting the new lens.”

Note: NCCI 11.3 takes effect on Oct. 1. To download the complete set of NCCI 11.3 edits, visit the Web site www.cms.hhs.gov/physicians/cciedits.

No Need for Ob-Gyn's Presence on TC/26 Code

Question: We-re charging for a fetal non-stress test (NST). Is it OK if the ob-gyn was not present on the day the patient underwent the NST?

The code for the NST (59025, Fetal non-stress test) has both a technical (modifier TC, Technical component) and professional component (modifier 26, Professional component) and no requirement for direct physician supervision. 

Important: If your ob-gyn wasn't present for the NST performed at the hospital and documented the interpretation, you should report 59025-26. The hospital would then report 59025-TC. If the patient underwent the NST in the office, you should report 59025 alone.