Hint: You might not need as many codes on the claim as you expect.
CPT 2010 lists several codes for spirometry testing under “Other Procedures” in the Medicine section. The next time you’re faced with determining the best code for a patient, be sure you know the differences between these most-common options — and which codes you don’t need to include on your claim.
Look to 94010 As Your First Choice
When coding spirometry, the most frequent choice for most pediatricians is 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation).
Scenario: An established patient presents for a follow-up visit after an episode of respiratory distress where she needed a nebulizer or inhaler treatment. The staff evaluates the child’s respiratory status at that visit and treats the child. You report 94010 along with an E/M code for the office visit; experts say the child’s significant subsequent management merits 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity …).
“You don’t usually do spirometry when the patient is in acute distress because the reading will be low,” says Richard L. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. “You complete a spirometry test when the patient is stable, usually in a follow-up visit.”
Distinction: Providers sometimes struggle with how to bill for peak expository flow and wonder if they can report 94010 for the service. This is incorrect, because peak flow measurement (using a peak flow meter) is considered part of the E/M service. Spirometry, by contrast, is using a standardized instrument with a hard copy report and interpretation that becomes part of the patient’s record, Tuck explains.
Go Straight to 94060 for Pre- and Post-Tests
Sometimes a single treatment or test is enough; the pediatrician wants more information. In that case, she’ll administer a simple spirometry test, treat the patient with an inhaled bronchodilator, and conduct a follow-up spirometry test. This pre/post test approach is useful in establishing an asthma diagnosis.
“When we do a pre/post test, we use code 94060,” says Suzanne Wood, CPC, with Pulmonary Associates Medical Group in La Mesa, Cal. Again, report 94060 (Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration) with the appropriate E/M code.
Modifier tip: When the pediatrician completes a service in addition to E/M care, payers often require you to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. Wood and other coders, however, find that including modifier 25 with 94010 and 94016 is unnecessary. “I have no trouble getting paid in addition to an E/M service and I do not need to use a 25 modifier,” Wood says. Check your payer’s guidelines before filing your claim.
Supervision status: Code 94060 requires direct supervision. Ensure that a physician is present in the office suite and is immediately available to furnish assistance and direction throughout the procedure as needed.
Watch for Chances to Use 94664
Patients who use inhalers on a regular basis need to know they’re using the equipment correctly, especially when you’re dealing with children.
“If the child comes in for a well visit, ask how they use their inhaler,” suggests Victoria S. Jackson, a practice management consultant with JCM Inc. in California. “Show them how to use it correctly if necessary and report 94664.”
A trained non-physician practitioner (NPP) or physician can perform the demonstration. Provideappropriate documentation in either situation, and have the supervising physician countersign the NPP’s notes.
Bonus: Taking that simple step with your established patients can garner extra pay each time you report 94664 (Demonstration and/or evaluation ofpatient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). To find out how, subscribe to the Pediatric Coding Alert. Editor: Leigh DeLozier, CPC.
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