Why Pulmonology billing is different.
Pulmonology billing expertise.
- Spirometry and complete pulmonary function test coding
- Bronchoscopy with BAL, biopsy and EBUS coding
- In-lab and home sleep study billing
- Critical care time-based coding
- Professional and technical component billing for testing
- Six-minute walk and exercise testing claims
- Oxygen and DME documentation support
- Hospital and ICU rounding billing
Common Pulmonology codes we work with.
| Code | Description |
|---|---|
94010 | Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement |
94060 | Bronchodilation responsiveness, spirometry pre- and post-bronchodilator administration |
94729 | Diffusing capacity (add-on code) |
31624 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed; with bronchial alveolar lavage |
95810 | Polysomnography, age 6 years or older, sleep staging with 4 or more additional parameters, attended by a technologist |
94618 | Pulmonary stress testing (e.g., 6-minute walk test), including measurement of heart rate, oximetry and oxygen titration |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processPulmonology billing process.
Eligibility and Authorization
- Benefit verification for testing and procedures
- Sleep study authorization and setting requirements
- Hospital and ICU patient setup
- Patient estimates for testing
Coding
- PFT component coding with correct bundling
- Bronchoscopy technique coding
- Critical care time calculation
- Component modifiers for hospital-based testing
Claim Submission
- Scrubbing for testing and procedure edits
- Correct place of service for each setting
- Diagnosis linking for testing medical necessity
- Electronic submission within 24 hours
Denial Management
- Medical necessity appeals for testing
- Sleep study authorization disputes
- Critical care documentation follow-up
- Bundling corrections
Analytics
- Testing volume and revenue
- Hospital versus office revenue mix
- Payer reimbursement trends
- Denials by service type
Pulmonology billing FAQs.
Which pulmonary function tests can be billed together?
Some tests, such as spirometry and bronchodilator responsiveness, bundle together, while diffusing capacity and lung volumes are billed as add-ons. We apply NCCI edits so you bill the complete set of tests you performed without unbundling.
How is critical care time billed?
Critical care is billed by total time spent on the patient's critical care on a given date, starting at 30 minutes, with add-on units for additional time. Your documentation should state total time and the critical nature of the care.
Do payers require home sleep testing first?
Many payers require a home sleep apnea test for uncomplicated patients before approving an in-lab study. We check each payer's policy and obtain authorization for the appropriate setting.
How are bronchoscopies with multiple procedures coded?
Each distinct technique, such as lavage, brushing or biopsy, may be separately coded following endoscopy family rules. We code from the procedure note to capture every billable service.