DB5 Question 1
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Erin Pickles posted Nov 14, 2023 1:38 PM
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1. A 62-year-old man comes into the practice where you work
complaining of bronchospasm. Spirometry is administered
before and after a bronchodilator to measure the patient’s lung
capacity. How are these procedures coded? What pulmonary
tests are included in a complete spirometry, and how are they
coded? What must you take into consideration when coding
spirometry? [Tips: Spirometry is a common breathing capacity
procedure with many variations, coded in the range of 9401094070. Spirometry can be patient-initiated or performed in a
laboratory. In patient-initiated spirometry, codes range from
94014-94016. A spirometry performed before and after the
bronchodilator is reported with (Fill in the blanks, 940–).
Bronchodilators are coded separately with (Fill in the blanks,
990–). Complete spirometry is coded as (Fill in the blanks,
940–). When coding spirometry, coders need to know whether
the procedure is performed in a laboratory or is patientinitiated. Is this a complete procedure? Are there any other
pulmonary function tests the physician requests?]
The diagnosis for the 62-year-old man is bronchospasm,
which is the formation of the lung due to a spastic contraction
of the bronchial muscles. A spirometry, which gauges a
patient’s capacity for breathing, was the standard approach he
underwent. Spirometry is a highly effective test for the early
identification of numerous lung illnesses. Both patient-initiated
and laboratory-performed spirometry are available. The same
measures are obtained by patient-initiated spirometry (9401494016), which transmits data collected from the patient’s
location to the pulmonary laboratory over the phone. The
codes available for laboratory-performed spirometry are
(94010/94060), while patient-initiated ones are (9401494016). A 30-day period of imagery recordings, data analysis,
machine recalibration on a regular basis, physician assessment
and interpretation of results, and instructions on equipment use
from the technician are all included in the patient-initiated
procedure represented by the code (94014). Only the recording
component is represented by (94015) along with code (94016)
which is exclusively for the analysis and interpretation of the
findings. When a bronchodilator is utilized with spirometry the
code (94060) is used. Here, bronchodilators are given prior to
as well as after the test in order to observe if the values rise
following administration. Spirometry is then conducted. On the
other hand, basic spirometry is represented by the code
(94010). A variety of specifications including measures and
values, with the delivery of irritating substances, for instance,
cold air, are included in the basic spirometry test represented
by the code (94070). Prior to using a bronchodilator, lung
function is measured using pre- and post-bronchodilator
measurements. This will have its own code, (99070).
Module 5 Discussion Question 1
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McKenzie Rogman posted Nov 14, 2023 2:41 PM
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1. A 62-year-old man comes into the practice where you
work complaining of bronchospasm. Spirometry is
administered before and after a bronchodilator to
measure the patient’s lung capacity. How are these
procedures coded? What pulmonary tests are included in
a complete spirometry, and how are they coded? What
must you take into consideration when coding
spirometry? [Tips: Spirometry is a common breathing
capacity procedure with many variations, coded in the
range of 94010-94070. Spirometry can be patientinitiated or performed in a laboratory. In patient-initiated
spirometry, codes range from 94014-94016. A spirometry
performed before and after the bronchodilator is reported
with (Fill in the blanks, 940–). Bronchodilators are coded
separately with (Fill in the blanks, 940–). When coding
spirometry, coders need to know whether the procedure
is performed in a laboratory or is patient-initiated. Is this a
complete procedure? Are there any other pulmonary
function tests the physician requests?]
Spirometry is the most common pulmonary function tests. It
measures lung function, specifically the amount and speed of
air that can be inhaled and exhaled. It may be ordered for
someone who is wheezing, short of breath, or has a cough. If
you are just coding for spirometry, you would use 94010. If you
are coding spirometry with bronchodilator you would then use
the code 94060. When using these codes, better
reimbursement happens when current symptoms are associated
with the appropriate ICD9 code for asthma and/or COPD.
In a complete spirometry, you will have a pulmonary screening
and a complete pulmonary function test. The pulmonary
screening measures pulmonary flows. It is performed in a
physician’s office to determine the presence of disease and is
also used for in-hospital, pre-general anesthesia evaluation of
pulmonary status. The complete pulmonary function test is
used to measure lung volumes, capacities, airway resistance,
and diffusion. A screening spirometry is part of every complete
pulmonary function test. The pulmonary screening is typically
coded as 94010 or 94060. The complete test is coded as
94726 or 94727.
When coding spirometry it is important to know the correct
way to code a specific pulmonary test that falls into this
category. There is a code(s) for spirometry tests, codes for lung
volume tests, codes for diffusion capacity tests, and even for
stress testing. It is vital that coders are accurately coding the
correct procedure and what is actually being done or examined
on/for the patient. It is also important to know, in order to code
for spirometry, whether or not the procedure was patientinitiated or done in the laboratory.
Module 5 Question 1
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Jill Heflin posted Nov 13, 2023 5:22 PM
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A 62-year-old man comes into the practice where you work
complaining of bronchospasm. Spirometry is administered
before and after a bronchodilator to measure the patient’s lung
capacity. How are these procedures coded? What pulmonary
tests are included in a complete spirometry, and how are they
coded? What must you take into consideration when coding
spirometry? [Tips: Spirometry is a common breathing capacity
procedure with many variations, coded in the range of 9401094070. Spirometry can be patient-initiated or performed in a
laboratory. In patient-initiated spirometry, codes range from
94014-94016. A spirometry performed before and after the
bronchodilator is reported with (Fill in the blanks, 940–).
Bronchodilators are coded separately with (Fill in the blanks,
990–). Complete spirometry is coded as (Fill in the blanks,
940–). When coding spirometry, coders need to know whether
the procedure is performed in a laboratory or is patientinitiated. Is this a complete procedure? Are there any other
pulmonary function tests the physician requests?]
Spirometry is a common test that measures the breathing
capacity and has several variations. As seen in this case where
the patient is complaining of bronchospasm, a physician would
order a spirometry test as it is the best test for early detection
of lung disorders. A spirometry test can either be performed in
a laboratory (94010/94060) or be patient- initiated
(94014/94060). When a patient has a spirometry test
performed in a laboratory, a technician measures the patient’s
breathing capacity. In regard to a patient- initiated test, the
results are in the same measurement, but the data will need to
be submitted via telephone transmission. The CPT code 94014
includes the technician instructing the patient on the use of the
machine, graphic recordings, analysis of the data, periodic
recalibration of the machine, and physician review and
interpretation of the results for a 30-day period. In a patientinitiated test, the code 94015 represents the recording
component only and 94016 is for the review and interpretation
of the results only.
A basic spirometry test is coded as 94010. A spirometry
performed before and after a bronchodilator is reported with
the code 94060. This test measures the lung capacity before
and after the bronchodilator was administered to see if the
values increased. The CPT code 99070 represents the
bronchodilators only. A complete spirometry (94070) includes
the following: flow volume loop; prebronchodilator flow rates;
postbronchodilator values; maximal ventilation values. A
physician would determine what is to be included in their
complete pulmonary function test. Often a pulmonary function
tests includes spirometry, lung volume determination, and
diffusing capacity. Other examples of a pulmonary test that a
physician may request includes Functional Residual Capacity;
Thoracic Gas Volume; Diffusion Capacity of Carbon Monoxide;
Airway Resistance.
Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next step:
Advanced Medical Coding and Auditing, 2021/2022. Elsevier.
Module 5 Question 1
Contains unread posts
Pamela Nyagah posted Nov 13, 2023 7:24 PM
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A 62-year-old man comes into the practice where you work complaining of
bronchospasm. Spirometry is administered before and after a bronchodilator to
measure the patient’s lung capacity. How are these procedures coded? What
pulmonary tests are included in a complete spirometry, and how are they coded?
What must you take into consideration when coding spirometry? [Tips: Spirometry
is a common breathing capacity procedure with many variations, coded in the range
of 94010-94070. Spirometry can be patient-initiated or performed in a laboratory. In
patient-initiated spirometry, codes range from 94014-94016. A spirometry
performed before and after the bronchodilator is reported with (Fill in the blanks,
940–). Bronchodilators are coded separately with (Fill in the blanks, 990-). Complete spirometry is coded as (Fill in the blanks, 940–). When coding
spirometry, coders need to know whether the procedure is performed in a laboratory
or is patient-initiated. Is this a complete procedure? Are there any other pulmonary
function tests the physician requests?]
In medical coding, spirometry is a crucial procedure to assess lung function and is
coded carefully to accurately represent the service provided (Graham et al., 2019).
In the scenario of a 62-year-old man undergoing spirometry before and after
bronchodilator administration, specific coding rules apply.
Spirometry Coding
1.Pre and Post Bronchodilator Spirometry: When spirometry is performed both
before and after administering a bronchodilator, it is reported with code 94060. This
code reflects the measurement of breathing capacity and the assessment of
bronchodilator effectiveness.
2.Bronchodilator Administration: The administration of bronchodilators is coded
separately. Typically, this service is captured using codes in the range of 99070 or
specific J codes, depending on the medication used and the method of administration.
3. Complete Spirometry: A complete spirometry, which includes measurements like
Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1),
and the FEV1/FVC ratio, is coded as 94010. This code encompasses the full scope
of basic spirometry testing (Lamb, Theodore and Bhutta, 2020).
Considerations for Coding Spirometry:
When coding for spirometry, several factors must be considered to ensure accurate
and appropriate billing:
1. Location and Type of Procedure: It’s important to distinguish whether the
spirometry is performed in a laboratory setting or is patient-initiated.
Laboratory spirometry’s are typically coded under the 94010-94070 range. In
contrast, patient-initiated procedures, which involve the patient using a home
spirometer over a period, are coded with 94014-94016.
2. Completeness of the Procedure: Coders need to ascertain if the spirometry
performed is a complete procedure (94010) or a more specific test like pre-
and post-bronchodilator testing (94060). The specific test performed will
guide the appropriate coding.
3. Additional Pulmonary Function Tests: If the physician requests additional
pulmonary function tests beyond basic spirometry, such as lung volume
measurement (94240) or diffusion capacity (94729), these should be coded
separately. Each test has its specific code, and accurate documentation is key
to selecting the right one.
4. Documentation and Clinical Notes: Accurate and thorough documentation by
the healthcare provider is crucial. This includes details about the procedure,
the medications used, the reasons for testing (such as bronchospasm in this
case), and any additional tests performed. Coders rely on this information to
apply the most accurate codes.
In conclusion, coding for spirometry involves a detailed understanding of the
procedure, its variations, and the specific context in which it is performed. The
correct application of codes like 94010, 94060, and others in the spirometry range
ensures that the services are accurately represented and billed.
Sources
Graham, B.L., Steenbruggen, I., Miller, M.R., Barjaktarevic, I.Z., Cooper, B.G.,
Hall, G.L., Hallstrand, T.S., Kaminsky, D.A., McCarthy, K., McCormack,
M.C., Oropez, C.E., Rosenfeld, M., Stanojevic, S., Swanney, M.P. and
Thompson, B.R. (2019). Standardization of Spirometry 2019 Update. An
Official American Thoracic Society and European Respiratory Society
Technical Statement. American Journal of Respiratory and Critical Care
Medicine, 200(8), pp.e70–e88. doi:https://doi.org/10.1164/rccm.2019081590st.
Lamb, K., Theodore, D. and Bhutta, B.S. (2020). Spirometry. [online] PubMed.
Available at: https://www.ncbi.nlm.nih.gov/books/NBK560526/.
Part #2
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Elizabeth Krueger posted Nov 13, 2023 11:45 AM
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Module #5
Part #2
2. A 35-year-old man has undergone a nephrectomy for
removal of a healthy kidney.
Why would someone need this surgery, and what else
must you know to code the procedure properly?
Does the lack of disease to the kidney affect how you code
the procedure?
[Tips: Think about why would an individual donate a
healthy kidney?
Are the codes for the procedure affected by the condition
of the organ?
Was the surgery performed with an open approach (Fill
in blanks, 50300- 503–) or a laparoscopic procedure (Fill
in the blanks, 50543- 505–)?]
A nephrologist specializes in the treatment of conditions
of the kidney and has special education and training in kidney
disease and dialysis therapy as well as transplantation.
Nephrology is a subspecialty of internal medicine (369).
A 35-year-old man has undergone a nephrectomy for
removal of a healthy kidney. A nephrectomy is the partial or
total removal of the kidney that may be performed due to
disease. It is stated in this patient’s case his kidney is healthy,
he is likely donating a kidney (a total removal). The
procedure can be performed as an open approach (50220-
50240) or as a laparoscopic procedure (50543, 50545, or
50548, which include a donor nephrectomy).
Urinary System subsection in the CPT manual includes the
following categories: kidney, ureter (kidney to bladder),
bladder, and urethra (bladder to external body). It is very
important to know the anatomy of the urinary system when
coding from the subsection. It is all too easy to report the
wrong code, as all of the categories have many of the same
types of subcategories. It is crucial to make certain you are in
the correct category before assigning a code.
Source
Elsevier. (2020). Buck’s The Next Step: Advanced Medical
Coding and Auditing, 2021/2022 Edition. Saunders. pp.371.
Module 5 Question 2
Contains unread posts
Tara Sepe posted Nov 14, 2023 10:32 AM
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A 35-year-old man has undergone a nephrectomy for removal
of a healthy kidney. Why would someone need this surgery,
and what else must you know to code the procedure properly?
Does the lack of disease to the kidney affect how you code the
procedure? [Tips: Think about why would an individual donate
a healthy kidney? Are the codes for the procedure affected by
the condition of the organ? Was the surgery performed with an
open approach (Fill in the blanks, 50300-503–) or a
laparoscopic procedure (Fill in the blanks, 50543-505–)?]
A nephrologist specializes in the treatment of conditions of the
kidney and has certain education and training in kidney disease
and dialysis therapy as well as transplantation. It is important to
have an abundance of nephrologists in healthcare because
kidney disease is so prevalent in today’s day and age. These are
also not to be confused with urologists, who specialize in the
diagnosis and treatment of conditions of the urinary system.
They also specialize in male genitourinary conditions and often
treat patients with prostatitis, benign prostatic hyperplasia, and
prostate cancer. Nephrology is a subspecialty of internal
medicine.
A nephrectomy can either be a partial or total removal of one’s
kidney. These are performed because of disease or when an
individual is donating their kidney. The procedure can be
performed using an open approach (50220-50240) or a
laparoscopic procedure (50543, 50545, or 50548, which
includes a donor nephrectomy).
Overall, it is extremely important for physicians and coders to
understand how a kidney procedure is performed, as well as the
correct way to code the procedure. As we all know, coding
correctly is crucial for the billing and reimbursement process as
well as the organization as a whole.
Reference
Koesterman, J. L., & Buck, C. J. (2021a). Buck’s the next step:
Advanced Medical Coding and Auditing, 2021/2022. Elsevier.
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