Only after methacholine has been administered will your pulmonologist perform a baseline spirometric reading. You thus cannot report this or any other subsequent spirometries with 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation) as the code 94070 includes spirometric readings associated with methacholine testing.
“An initial spirometry could be reported separately with a 59 modifier (Distinct procedural service), 94010-59, but only if that test were used to make the decision to perform the methacholine challenge,” says Plummer.
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Plummer offers following example to explain:
“An established patient with a persistent cough is seen in the office for a level 4 exam. Screening spirometry revealed normal values. A decision was made to schedule a methacholine challenge which was performed later that same day.
You would code 99214 (Office or other outpatient visit for the evaluation and management of an established patient which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family), 94010-59, 95070, 94070, J7674x10.” In this scenario, since the spirometry was done prior to the methacholine challenge test, you can report it by adding the modifier.
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