Pulmonary Function Test CPT Codes | Descriptions & Billing Guide

CPT 96618, CPT 94621, and CPT 94617 can be used as Pulmonary Function Test CPT Codes. Other codes used for this procedure are CPT 94010, CPT 94200, CPT 94640, CPT 94726, CPT 94727, and CPT 94729. Below are the billing guidelines and descriptions of the Pulmonary Function Test CPT codes.

Multiple non-invasive tests should be used to assess the patient’s pulmonary parameters and provide insight into the patient’s lung function, disease pattern, and degree of impairment.

The CPT code for the pulmonary function test in spirometry is CPT 94010. Spirometry is one of PFT’s most significant components, serving as the foundation for most pulmonary function tests.

Spirometry measures how much air can be ejected from the patient’s lungs and how quickly it can be done (vital capacity).

CPT codes for Pulmonary function tests can be used for lung health. Lung capacity, flow rates, and oxygen exchange will also assess.

This data can be aided in diagnosing and treating specific lung problems, so be sure to share it with your doctor if you’re experiencing any symptoms. 

Several diagnostic procedures assess respiratory function and fall under the umbrella term pulmonary function tests. The CPT code for plethysmography measures lung volume and capacity, and CPT code 94726 can be used for pulmonary function tests. 

Plethysmography can be used to distinguish between restrictive and obstructive lung disorders.

In addition to aiding in identifying airway resistance, measuring lung capacity at various periods during the breathing cycle helps to determine lung capacity.

As an alternative to plethysmography, lung volume can be measured using gas dilution and is described by CPT code 94727 for pulmonary function assessment. In addition, this pulmonary function test CPT code can be used to determine ventilation distribution and residual air volume.

The patient inhales from a container holding a fixed volume of gas (often helium), and the physician records the concentration of the gas over time using CPT code 94727.

Note that the 94726 CPT code procedure should not be submitted alongside the CPT code for pulmonary function tests. 

The diffusing capacity for oxygen (DLCO) test helps distinguish between intrinsic and extrinsic pulmonary operations. The extent of parenchymal degradation in individuals with chronic obstructive lung diseases can be assessed.

It’s also a tool for diagnosing pulmonary vascular and interstitial diseases. CPT code 94729 can be reported as a pulmonary function test that measures diffusion capacity; it can often be reported alongside the pulmonary function test CPT codes 94726 and 94010.

Description Of The Pulmonary Function Test CPT Codes

The CPT codes for Pulmonary Function Test can be found in CPT’s manual as CPT 96618, CPT 94621, and CPT 94617. The Pulmonary Function Test CPT codes are described below.

CPT 94618: The 94618 CPT code can be billed for pulmonary function tests and is officially described in CPT’s manual as: “Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed.

CPT 94621: The 94621 CPT code can be billed for pulmonary function tests and is officially described in CPT’s manual as: “Cardiopulmonary exercise testing, including measurements of minute ventilation, CO2 production, O2 uptake, and electrocardiographic recordings.”

CPT 94617: The 94621 CPT code can be billed for pulmonary function tests and is officially described in CPT’s manual as:“Exercise test for bronchospasm, including pre-and post-spirometry and pulse oximetry; with electrocardiographic a recording or recordings.”

CPT 94621: The 94621 CPT code can be billed for pulmonary function tests and is officially described in CPT’s manual as:

Other useful CPT codes to report alongside the CPT code for Pulmonary Function Test (CPT 94618) can be found in CPT’s manual as CPT 94617, CPT 94010, CPT 94200, CPT 94640, CPT 94726, CPT 94727, and CPT 94729.

CPT 94010: The 94010 CPT code is officially described in CPT’s manual as: “Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation.”

CPT 94200: The 94200 CPT code is officially described in CPT’s manual as: “Maximum breathing capacity, maximal voluntary ventilation.”

CPT 94640: The 94640 CPT code is officially described in CPT’s manual as: “Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device.

CPT 94726: The 94726 CPT code is officially described in CPT’s manual as: “Plethysmography for determination of lung volumes and, when performed, airway resistance.”

CPT 94727: The 94727 CPT code is officially described in CPT’s manual as: “Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.”

CPT 94729: The 94010 CPT code is officially described in CPT’s manual as: “Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure).”

A pulmonary functioning test can be evaluated lung function by observing the patient’s integrated response to an increased workload.

Three separate approaches include pulmonary stress testing:

• Report CPT code 94618 for a six-minute walk test for pulmonary function procedure and supply.
• Report CPT 94621 for cardiopulmonary exercise testing.
• Report CPT 94617 for a bronchospasm exercise test.

Aerosol treatment refers to providing medication to a patient by delivering the substance directly into the patient’s airways or lungs using an inhaler. If the patient receives aerosol therapy for less than one hour, CPT code 94640 should be used. 

If the patient receives continuous inhalation therapy for more than one hour, however, the first hour will be invoiced using CPT code 94644, and each hour after that could bill using CPT code 94645.

CPT 94664 is the code for the gadget demonstration (commonly inhalers). During this brief consultation, patients will instruct to use their inhalers and spacers correctly. Typically, this service can be covered once per beneficiary by the insurance company.

Since 2014, Medicare has expanded its coverage of smoking cessation therapies and counseling for adults. The following CPT codes could use to bill for smoking cessation counseling:

• The 99406 code indicates intermediate counseling sessions lasting between 3 and 10 minutes.
• Counseling sessions for pulmonary function tests can last more than 10 minutes.
• Medicare will cover up to four counseling sessions each stop attempt, but only twice annually.

Billing Guidelines For The CPT Codes For Pulmonary Function Test

The code governing their handling includes demonstrating how to deal with aerosols. Since the demonstration is a particular service, it should bill if it will provide at a different time, and the modifier 59 should indicate this to the payer.

Before billing a CPT code for pulmonary function test, ensure that you are familiar with the payer’s billing and payment policies. Spirometry is crucial for diagnosing and treating lung disorders.

If lung disease or anomalies in lung function are suspected, a pulmonary function test CPT code procedure of this can be helped to pinpoint the problem.

• The severity of disability can be affected due to impaired pulmonary function.
• Illness development.
• Type of disease or tumor.
• Drug-induced lung disease or compromised lung function

A pulmonary function test CPT code procedure enables the physician to evaluate the severity of airway obstruction and the efficacy of the existing medicine.

CPT code 96618 allows customizing the medication to ensure adequate daily control. After completing a pulmonary function test CPT code procedure, the test findings can be analyzed and interpreted.

The doctor’s office offers appointments, PFT interpretation, nebulizer sets, a compressor, liquid or inhaled albuterol, and normal saline. Patients should train on how to use an inhaler and spacer during this appointment and be given homework to ensure that they do so. 

The inhaler and spacer should be brought by patients receiving instructions. This procedure typically takes no more than a quarter-hour.

Even though most payers cover educational and training fees, they should not do so if given in conjunction with other services. Ensure you understand the payer’s billing and payment policies before submitting a bill.

The doctor schedules the visit, writes the prescription(s), and recommends using a spacer. The use of spacers can be incorporated into the payment plans of nearly all service providers.

Depending on the circumstances, they could cover as either a pharmaceutical benefit or a piece of durable medical equipment. Continuous oxygen monitoring may be advantageous for a patient with COPD who must walk. 

This non-invasive method examines the oxygen levels in the patient’s blood. It should be administered to all patients experiencing difficulty breathing.

Patients getting treatment for pulmonary fibrosis may need to undergo respiratory testing more frequently than once per year, maybe as often as four times per year.

Does Medicare Cover Pulmonary Function Test CPT Code 94618?

 Medicare will only cover repeated testing if it is deemed medically essential based on the patient’s current health status and the expected clinical value of the test results.

Medicare requires precise documentation of chronic conditions and diagnoses requiring regular laboratory testing.

How To Use Modifier 25 With CPT Codes For Pulmonary Function Test

According to NCCI standards, modifier 25 should be reported with an E&M code when invoiced on the same service date as pulmonary testing codes CPT 94010 – CPT 94799.

While performing pulmonary diagnostic, therapeutic, or monitoring procedures, you and your team must be familiar with the definitions of CPT 99211 – CPT 99213 and the proper application of modifier 25.

Suppose a physician doing pulmonary diagnostic tests or therapy conducts only a brief physical exam and collects a little history immediately connected to the testing or treatment.

In that case, it is unnecessary to report an E&M service separately. Modifier 25 should be used to indicate that in addition to pulmonary diagnostic testing or therapy, an E&M service could provide.

CPT code 90460 claims should be processed, but the service date cannot change. When billing for the same patient on the same service date, the same doctor also included a bill using CPT code 99212 without a modifier.

CPT code 99212 should not be billed if the E/M service could link to CPT code 90460. It is not necessary to record an E/M service separately for pulmonary function testing because the doctor providing the test will also perform a physical examination pertinent to the testing.

If the E/M service was unrelated to CPT 90460, then modifier 25 can be used when billing for CPT 99211.

Can Pulmonary Function Tests Get Reimbursed?

The bundled nature of service CPT 94150 means that it can not be reimbursed separately.

The reimbursement for the pulmonary function test could govern by a set of CPT codes that classify and explain the numerous procedures performed within the scope of the test. The test can show the medical necessity of the following procedures.

In most cases, a pulmonary function test will reveal the following results:

• the presence of any dysfunction in respiratory function
• the nature of any dysfunction, the degree to which it hinders normal functioning,
• whether or not the patient’s present treatment is working, and what the best treatment option is for their condition.

Example

The patient, a caucasian female who is 60 years old, presents to the emergency room complaining of acute shortness of breath.

Around two days previously, the symptoms emerged and gradually worsened, but it was impossible to determine what factors contributed to, exacerbated, or relieved the condition.

A pulmonary functioning test CPT code can be used in this scenario.