When your pulmonologist performs a methacholine provocation challenge test to evaluate the responsiveness of a patient’s airways, he may use spirometry following the testing to see if there is a bronchospastic response. To report these services accurately, you’ll need to know how to report the tests, spirometry and any other E/M services provided during the encounter. Read on to get better grasp on the guidelines that will help you beat methacholine challenge test reporting when your pulmonologist performs them.
Know When to Report Professional and Technical Components Separately
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Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds). The methacholine provocation test should be reported using 94070 (Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents [e.g., antigen[s], cold air, methacholine]).
Key factors: To arrive at the right testing code, you’ll need to know “testing location, component services, coding edits, and additional visits,” advises Mary I Falbo, MBA, CPC, President of Millennium Healthcare Consulting, Inc., Lansdale, PA. “Code 94070 can be divided into a technical and professional component. For example, if the physician supervises and interprets the test in a hospital-based pulmonary function testing lab (PFT), he or she bills the professional component or interpretation with 94070 and appends modifier 26 (Professional component).”
“The professional interpretation and report (94070-26) may be provided by the physician apart from testing, and then the lab or hospital bills the technical component by appending modifier TC (Technical component) to 94070 if the lab administered the test,” says Falbo. “If the professional and technical components were performed in...
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