What Is the CPT Code for a Pulmonary Function Test?
Learn how CPT codes standardize billing for pulmonary function tests, ensuring clarity in lung health diagnostics.
CPT codes are standardized numerical codes used to report medical procedures, services, and supplies. They serve as a universal language for healthcare providers and payers, facilitating clear communication for billing and health records. Pulmonary Function Tests (PFTs) assess lung health, and this article clarifies their specific CPT codes.
Overview of Pulmonary Function Tests
Pulmonary Function Tests (PFTs) are non-invasive diagnostic tests that evaluate lung function. They measure lung volume, capacity, airflow rates, and gas exchange efficiency. PFTs diagnose respiratory conditions like asthma, chronic obstructive pulmonary disease (COPD), or pulmonary fibrosis. They also monitor disease progression, assess treatment effectiveness, and evaluate lung function before surgery.
Key CPT Codes for Pulmonary Function Tests
Specific CPT codes identify various pulmonary function tests, ensuring accurate reporting. The code chosen depends on the test performed, differentiating between basic and complex procedures.
Spirometry, a common PFT, measures exhaled air volume and flow. CPT code 94010 is for basic spirometry, including graphic records and measurements of vital capacity and expiratory flow rates. CPT code 94060 is used for spirometry performed before and after bronchodilator administration to assess airway responsiveness.
Lung volume measurements assess total lung capacity and residual air. CPT code 94726 is for lung volume determination using techniques like plethysmography or gas dilution. Plethysmography measures air in the lungs at full inhalation, providing information on capacity and resistance.
The diffusion capacity of the lung (DLCO) measures how effectively oxygen and carbon dioxide move between lung air sacs and the bloodstream. CPT code 94729 is for this test, typically involving single-breath carbon monoxide diffusing capacity. It identifies conditions impacting lung tissue, such as emphysema or pulmonary fibrosis. CPT code 94375 is for a respiratory flow-volume loop, providing a graphical representation of airflow during the entire respiratory cycle.
Applying CPT Codes in Medical Billing
After identifying appropriate CPT codes for pulmonary function tests, they are applied in medical billing and documentation. Codes are included on insurance claims, usually submitted electronically, to inform payers of services rendered. Accurate coding is fundamental for providers to receive reimbursement and maintain precise medical records.
Medical billers and coders translate medical documentation into standardized codes for claims submission. They ensure CPT codes align with procedures and supporting documentation is in order, preventing claim denials and payment delays.
Medical coding modifiers are appended to CPT codes to provide additional service information without altering the code’s basic meaning. Modifier -26 indicates the professional component of a service, representing the physician’s interpretation and report. Modifier -TC denotes the technical component, covering equipment, supplies, and technical personnel. These modifiers communicate specific circumstances to payers, influencing how the service is billed and reimbursed.