Coding Cues: Billing separately for spirometry

June 20, 2008

When evaluating our allergy patients, we normally order spirometry (94010). If it's warranted, we then order a bronchodilator (94060), followed by a second spirometry to assess the treatment's effectiveness. The charge for the initial spirometry is always rejected, as is the office visit. The first spirometry is to determine if a bronchodilator is indicated, so we consider it a separate service; the visit evaluates their overall status, so that should be a separate service as well. The visits are usually paid on appeal, but not the spirometry. Any suggestions?

Key Points

When evaluating our allergy patients (many of whom are asthmatic as a result of their allergies), we normally order spirometry (94010). If it's warranted, we then order a bronchodilator (94060), followed by a second spirometry to assess the treatment's effectiveness. The charge for the initial spirometry is always rejected, as is the office visit. The first spirometry is to determine if a bronchodilator is indicated, so we consider it a separate service; the visit evaluates their overall status, so that should be a separate service as well. The visits are usually paid on appeal, but not the spirometry. Any suggestions?

Pre- and post-spirometry are part of the description for 94060. So whenever you order a bronchodilator subsequent to an initial spirometry, the test can't be billed separately. Adding modifier -25 (significant, separately identifiable E&M service by the same physician on the same day of a procedure or other service) would indicate that you provided a service distinct from the pulmonary function evaluation, and should allow payment of your visits. However, your documentation must clearly support it. (You can also bill for the medication used for bronchodilation by reporting it with the appropriate "J" code.)