Mountain State Medical Policy Bulletin |
Section: | Diagnostic Medical |
Number: | M-19 |
Topic: | Pulmonary Function Studies |
Effective Date: | August 1, 2005 |
Issued Date: | January 30, 2006 |
Date Last Reviewed: | 01/2006 |
Indications and Limitations of Coverage
Pulmonary Function Studies Claims reporting only "Pulmonary function studies" will be processed under procedure code 94010. When a physician reports a "complete spirometry" (code 94010) and itemized charges for one or more of the following procedures, the charges will be combined and processed under code 94010. No additional allowance will be made unless they are performed independently.
Peak Expiratory Flow Rate (PEFR) using a Wright Peak Flow Meter is frequently done as a separate procedure apart from complete spirometry. If reported, payment will be made under procedure code S8110. Claims reporting bronchodilation responsiveness will be processed under procedure code 94060. A complete spirometry is included in this procedure; therefore, if an itemized charge is reported for spirometry when performed in conjunction with bronchodilation responsiveness, the charges will be combined and processed under code 94060. Patient Initiated Spirometry Patient initiated spirometry will be reimbursed only when indicated for the following conditions:
For asthmatic patients utilizing this service, the medical record must clearly delineate the above criteria. This service is defined as "patient initiated" with the intent that spirometry be performed by the patient in his/her home or domicile. It is therefore inappropriate to bill this service for a patient residing in any in-patient facility or for a patient being evaluated in an outpatient facility or physician office. Code 94014 describes the global service (i.e., both the professional and technical components of the service). Code 94015 describes only the technical component of the service, including recording, hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration. This code is not paid separately. Code 94016 describes only the physician (professional) component of the service. Description Pulmonary Function Studies Pulmonary function studies is a categorical term for diagnostic tests performed to determine how the lungs are functioning. Patient Initiated Spirometry Transtelephonic spirometry, also known as patient initiated spirometry, is a method of obtaining ongoing spirometric analysis of lung function. Transtelephonic spirometry requires the patient to perform the spirometry based on time intervals or criteria predetermined by the physician. The results are stored in a small computer that is part of the spirometer. The data is downloaded via modem from the spirometer's computer to another computer. The data is then trended and analyzed by the provider to identify problems. This service includes all measurements, transmissions and interpretations over a 30-day period. |
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94010 | 94014 | 94015 | 94016 | 94060 | 94150 |
94200 | 94375 | 94799 | S8110 |
How Accurate is Spirometry at Predicting Restrictive Pulmonary Impairment?, Chest, Vol. 115, No. 3, March 1999 |
[Version 001 of M-19] |