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"An increasing number of internists are performing spirometry (also referred to as pulmonary function tests or PFTs) as the equipment used for the tests has become less expensive and more portable. The increasing number of Medicare claims for PFTs, however, has caused local Medicare carriers to issue local medical reviews policies (LMRPs) that are very specific in detailing the medical coverage issues that must be met and covered diagnosis codes that must be reported in order to receive reimbursement for PFTs. The two spirometry codes that are used most by internists are code 94010 (spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) and code 94060 (bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). Spirometry is the most basic ventilation test done in a pulmonary function study. It is used for preoperative testing, to evaluate lung disease or the effect of another systemic disease on the pulmonary function, and to assess the effectiveness of treatment. A spirometer is used to perform the following measurements: tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume, inspiratory capacity, and vital capacity. Each measurement is usually taken three times and then an average result is calculated. However, only one unit of service can be billed for all of those measurements, says Cynthia DeVries, RN, CPC, coding and reimbursement specialist with Lee Physicians, a 140-physician practice with 27 internists in Ft. Myers, Fla. A bronchospasm evaluation is spirometry performed before and after a bronchodilator a drug that relaxes the bronchial muscles has been administered to the patient. Code 94010 is considered bundled into 94060 by both Medicare and CPT and cannot be reported separately. Whether a practice bills for the drugs used during the administration of a bronchospasm evaluation will often depend on the payer involved. DeVries practice does not bill separately for the broncholdilators. Because the CPT definition mentions the use of the drug, most of our payers interpret that to mean it is a standard component of the procedure, she explains. The Correct Coding Initiative doesnt include the J codes used to report drugs in its edits, so its hard to tell whether Medicare considers the drugs to be bundled with the procedure. Code for Symptoms, Not Risk Factors The key to getting consistent reimbursement for this service is to use an appropriate ICD-9 diagnosis code, according to DeVries. Most local Medicare carriers have a policy similar to the one of Nationwide Medicare, the Part B administrator for Ohio and West Virginia, which states, [R]egardless of the number of risk factors which a patient has, spirometry is not covered in the absence of symptoms. For more read:-
http://www.supercoder.com/articles/articles-alerts/ica/correct-diagnosis-code-is-key-to-consistent-reimbursement-for-spirometry/
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