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.
- Maximal Expiratory Flow Rate (MEFR) also known as Forced Expiratory
Flow (FEF 200-1200), 94799
- Maximal Mid Expiratory Flow Rate (MMEFR) also known as Forced Expiratory FEF 25-75), 94150.
- Maximal breathing capacity, maximal voluntary ventilation, 94200
- Vital capacity, total, 94150
- Vital capacity screening tests: Total capacity with timed forced expiratory volume (state duration), and peak flow rate, 94150.
- Various Forced Expiratory Volume studies such as FEV1, FEV1%, FEV2, or FEV3, 94799
- Respiratory flow volume loop, 94375
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:
Any patient utilizing this service must be mentally and physically capable of performing this test independently.
For asthmatic patients utilizing this service, the medical record must clearly delineate the above criteria.
The following codes are used to report patient initiated spirometry:
- 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.
- Code 94016 describes only the physician (professional) component of the service.
- NOTE:
- A spirometer (A9284, E0487) is included in the professional service and, therefore, is not eligible for separate reimbursement. A participating, preferred, or network provider cannot bill the member for the denied 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. |