Reader Question: Bust the Bundles to Code PFTs Properly
Question: We are getting different answers from Medicare and other insurance companies for billing nebulizations (94640) with an exercise study (94620) and with pre-post spirometry (94060). Can we bill nebulization with either of these CPT codes?
Tennessee Subscriber
Answer: You should review the National Correct Coding Initiative (NCCI) edits when billing 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB device)]), 94620 (Pulmonary stress testing; simple [e.g., prolonged exercise test for bronchospasm with pre- and post-spirometry]) and 94060 (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]).
NCCI bundles several codes under the bronchospasm evaluation (94060):
A bronchospasm evaluation involves using spirometry and bronchodilation. The allergist performs spirometry before and after administering a bronchodilator to dilate the airways.
In addition, NCCI bundles numerous codes into 94620:
Stress testing by definition includes the exercise test for bronchospasm with spirometry.
Based on this information, you will see that carriers will not reimburse 94640 separately when you report it with 94060. And they will not pay for 94060 separately from 94620. But NCCI does not bundle 94640 under 94620. Therefore, you can bill separately for inhalation treatment given on the same day as pulmonary stress testing as long as 94640 and 94620 are the only services the physician provides on that day. Otherwise, unbundling the 94640 and reporting it as a separate procedure would be inappropriate when the allergist performs it as a part of the 94060.
When you report these services separately, you should append modifier -59 (Distinct procedural service) to the code with fewer relative value units under the Medicare Physician Fee Schedule.
- Published on 2003-03-01
SuperCoder
