Billing For Pulmonary Procedures

For your convenience, below is a chart listing specific pulmonary procedures and their corresponding CPT codes that can be used as a quick reference when billing for asthma care services. In section B of this kit (Asthma Diagnosis/Patient Assessment Tools), is a sample assessment form that can be used to track and document asthma care services delivered at each patient visit.

The specific pulmonary services and physician responsibilities listed in the chart above are described below:

*Aerosol Treatment:
The code for aerosol treatment includes aerosol demonstration. If the demonstration is provided separately, it can be billed as a separate service with adequate documentation and use of the modifier 59 to alert the payer that it is a distinct and separate service. Always consult the payer’s billing and payment rules.

Pulmonary Function Testing:
Spirometry is a critical component for diagnosing and managing pulmonary disease.The test allows the physician to evaluate the degree of airway obstruction, the effectiveness of the current therapy, and gives the opportunity to customize medications to ensure adequate daily control.Test results are available immediately following the procedure for evaluation and interpretation.

Scheduling, interpretation of the PFT, nebulizer set-ups, compressor, liquid or inhaled albuterol for inhalation, and normal saline is supplied by the physician’s office. Most payers cover this service.

Demonstration:
During this session patients should be taught and expected to adequately demonstrate inhaler and spacer technique. Patients should bring their inhaler and spacer with them for teaching. This takes approximately 15 minutes. Most payers cover education and training, but they may not allow it to be reimbursed separately if it is provided with other services. You should consult the payer’s billing and payment rules.

The physician is responsible for scheduling the appointment and for prescribing the medication(s) and spacer for the patient. Most payers cover spacers. They may be covered as a pharmacy benefit, or may be considered durable medical equipment.

Pulse Oximetry:
This simple and painless procedure is done to evaluate oxygen levels of the patient. It is recommended for any patient that is in respiratory distress. For a patient that suffers with COPD, oximetry while walking may be required. Most payers cover this service.