CPT code 94010 & 94060 (Pulmonary function test) Coding Tips

Basics for Pulmonary function test CPT code 94010 & 94060

Spirometry is a critical component for diagnosing and managing pulmonary disease.The test allows the physician to evaluate the degree of airway obstruction, the effectiveness of the current therapy, and gives the opportunity to customize medications to ensure adequate daily control.Test results are available immediately following the procedure for evaluation and interpretation. Mainly CPT code 94010 & 94060 are used to report pulmonary function testing in medical coding.

General indications for any of the pulmonary function tests include:
• To determine the presence of lung disease or abnormality of lung function,
• To determine the type of abnormality,
• To determine the extent of abnormality,
• To determine the extent of disability due to abnormal lung function, and
• To determine and evaluate one or more courses of therapy in the treatment of the particular condition.

Pulmonary function test CPT code 94010 & 94060 Coding Tips

Read also: When to use Echocardiography CPT codes

Description of pulmonary function test CPT code 94010 & 94060

There are two primary types of pulmonary function tests

Pulmonary Screening: 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 (CPT code 94010 or 94060).

Complete Pulmonary Function Test: Complete pulmonary function tests are used to measure lung volumes, capacities, airway resistance, and diffusion. A screening spirometry is part of every complete pulmonary function test (CPT code 94726 or 94727)

94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation

94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration

In CPT code 94010, the spirometry measures expiratory airflow and volumes and forms the basis of most pulmonary function testing. While for  CPT code 94060, spirometry is performed before and after administration of a bronchodilator. CPT Code  94060 differs from code 94010 in that the administration of the bronchodilator is not included in code 94010.

CPT code 94060 should be reported when performing base spirometry measurement prior to inhalation of a bronchodilator to determine the patient’s response to the bronchodilator.

Read also: When to use Chest X ray CPT codes in Radiology

Pulmonary function test CPT code for Infants

CPT code 94011 -94013 are used to report Pulmonary function tests for measurements in infants and young children through 2 years of age.

94011 Measurement of spirometric forced expiratory flows in an infant or child through 2 years of age

94012 Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age

94013 Measurement of lung volumes (ie, functional residual capacity [FRC], forced vital capacity [FVC], and expiratory reserve volume [ERV]) in an infant or child through 2 years of age

A spirometer is an instrument that measures and records the volume of inhaled and exhaled air and is used to assess pulmonary function. This range of codes reports the measurement of spirometric forced expiratory flow in a patient 2 years of age or younger. Patients of this age often require sedation for testing in order to retain relaxed breathing. In one method, the child is positioned on a specialized bed. A technician places a mask over the child’s mouth and nose. A loose jacket-type bag is fitted around the chest and upper abdomen.

After the child takes a few breaths, the jacket bag inflates, giving the chest a gentle squeeze and forcing the air from the child’s lungs. In order to measure lung size, the technician closes the upper portion of the bag and air flow through the mask is briefly discontinued. The resultant change in air pressure allows the computer to measure lung size. Use CPT code 94011 for measurements obtained without the use of bronchodilators and 94012 for those obtained before and after the use of a bronchodilator. These codes include laboratory procedures and the interpretation of test results.

CPT Code 94013 may be performed with spirometric forced expiratory flows, and reported with either code 94011 or 94012. If warranted, code 94013 may be reported twice on the same day (eg, before and after bronchodilator)

Read also: Coding guide for Cardioversion CPT code 92960 & 92961

NCCI edits for 94010 and 94060 CPT code

Many CPT codes have NCCI edits with CPT code 94010 and 94060, we have a list of them to check and use 59 or X modifier when needed to bypass the edits.

Major Code/Column 1Minor Code/Column 2Modifier/Policy Indicator
940105200-Not allowed
940100243T1-Allowed
940100244T1-Allowed
94010365910-Not allowed
94010365920-Not allowed
94010941501-Allowed
94010941509-Not applicable
94010941600-Not allowed
94010942001-Allowed
94010943750-Not allowed
94010946401-Allowed
94010947280-Not allowed
94010950701-Allowed
94010950711-Allowed
94010965230-Not allowed
94010992011-Allowed
94010992011-Allowed
94010992021-Allowed
94010992021-Allowed
94010992031-Allowed
94010992031-Allowed
94010992041-Allowed
94010992041-Allowed
94010992051-Allowed
94010992051-Allowed
94010992111-Allowed
94010992111-Allowed
94010992121-Allowed
94010992121-Allowed
94010992131-Allowed
94010992131-Allowed
94010992141-Allowed
94010992141-Allowed
94010992151-Allowed
94010992151-Allowed
94010992419-Not applicable
94010992429-Not applicable
94010992439-Not applicable
94010992449-Not applicable
94010992459-Not applicable
94010992811-Allowed
94010992811-Allowed
94010992821-Allowed
94010992821-Allowed
94010992831-Allowed
94010992831-Allowed
94010992841-Allowed
94010992841-Allowed
94010992851-Allowed
94010992851-Allowed
94010993041-Allowed
94010993041-Allowed
94010993051-Allowed
94010993051-Allowed
94010993061-Allowed
94010993061-Allowed
94010993071-Allowed
94010993071-Allowed
94010993081-Allowed
94010993081-Allowed
94010993091-Allowed
94010993091-Allowed
94010993101-Allowed
94010993101-Allowed
94010993151-Allowed
94010993151-Allowed
94010993161-Allowed
94010993161-Allowed
94010993181-Allowed
94010993241-Allowed
94010993251-Allowed
94010993261-Allowed
94010993271-Allowed
94010993271-Allowed
94010993281-Allowed
94010993281-Allowed
94010993341-Allowed
94010993341-Allowed
94010993351-Allowed
94010993351-Allowed
94010993361-Allowed
94010993361-Allowed
94010993371-Allowed
94010993371-Allowed
94010993411-Allowed
94010993411-Allowed
94010993421-Allowed
94010993421-Allowed
94010993431-Allowed
94010993431-Allowed
94010993441-Allowed
94010993441-Allowed
94010993451-Allowed
94010993451-Allowed
94010993471-Allowed
94010993471-Allowed
94010993481-Allowed
94010993481-Allowed
94010993491-Allowed
94010993491-Allowed
94010993501-Allowed
94010993501-Allowed
94010994831-Allowed
94010994831-Allowed
94010994971-Allowed
94010994971-Allowed
94010994979-Not applicable
94010G04631-Allowed
94010G05051-Allowed
Major Code/Column 1Minor Code/Column 2Modifier/Policy Indicator
940605200-Not allowed
940600243T0-Not allowed
940600244T0-Not allowed
940600708T1-Allowed
940600709T1-Allowed
94060360001-Allowed
94060364101-Allowed
94060365910-Not allowed
94060365920-Not allowed
94060907601-Allowed
94060907651-Allowed
94060907721-Allowed
94060907741-Allowed
94060907751-Allowed
94060907801-Allowed
94060940100-Not allowed
94060940111-Allowed
94060940121-Allowed
94060941509-Not applicable
94060941501-Allowed
94060941600-Not allowed
94060942001-Allowed
94060943750-Not allowed
94060946209-Not applicable
94060946401-Allowed
94060946501-Allowed
94060946641-Allowed
94060947280-Not allowed
94060947609-Not applicable
94060947619-Not applicable
94060947701-Allowed
94060950709-Not applicable
94060950711-Allowed
94060963601-Allowed
94060963651-Allowed
94060963721-Allowed
94060963741-Allowed
94060963751-Allowed
94060963761-Allowed
94060963771-Allowed
94060965230-Not allowed
94060992011-Allowed
94060992011-Allowed
94060992021-Allowed
94060992021-Allowed
94060992031-Allowed
94060992031-Allowed
94060992041-Allowed
94060992041-Allowed
94060992051-Allowed
94060992051-Allowed
94060992111-Allowed
94060992111-Allowed
94060992121-Allowed
94060992121-Allowed
94060992131-Allowed
94060992131-Allowed
94060992141-Allowed
94060992141-Allowed
94060992151-Allowed
94060992151-Allowed
94060992419-Not applicable
94060992429-Not applicable
94060992439-Not applicable
94060992449-Not applicable
94060992459-Not applicable
94060992811-Allowed
94060992811-Allowed
94060992821-Allowed
94060992821-Allowed
94060992831-Allowed
94060992831-Allowed
94060992841-Allowed
94060992841-Allowed
94060992851-Allowed
94060992851-Allowed
94060993041-Allowed
94060993041-Allowed
94060993051-Allowed
94060993051-Allowed
94060993061-Allowed
94060993061-Allowed
94060993071-Allowed
94060993071-Allowed
94060993081-Allowed
94060993081-Allowed
94060993091-Allowed
94060993091-Allowed
94060993101-Allowed
94060993101-Allowed
94060993151-Allowed
94060993151-Allowed
94060993161-Allowed
94060993161-Allowed
94060993181-Allowed
94060993241-Allowed
94060993251-Allowed
94060993261-Allowed
94060993271-Allowed
94060993271-Allowed
94060993281-Allowed
94060993281-Allowed
94060993341-Allowed
94060993341-Allowed
94060993351-Allowed
94060993351-Allowed
94060993361-Allowed
94060993361-Allowed
94060993371-Allowed
94060993371-Allowed
94060993411-Allowed
94060993411-Allowed
94060993421-Allowed
94060993421-Allowed
94060993431-Allowed
94060993431-Allowed
94060993441-Allowed
94060993441-Allowed
94060993451-Allowed
94060993451-Allowed
94060993471-Allowed
94060993471-Allowed
94060993481-Allowed
94060993481-Allowed
94060993491-Allowed
94060993491-Allowed
94060993501-Allowed
94060993501-Allowed
94060994831-Allowed
94060994831-Allowed
94060994971-Allowed
94060994971-Allowed
94060994979-Not applicable
94060C89501-Allowed
94060C89521-Allowed
94060G03451-Allowed
94060G03471-Allowed
94060G03511-Allowed
94060G03531-Allowed
94060G03541-Allowed
94060G04631-Allowed
94060G05051-Allowed

Related Pulmonary function test CPT codes

94726 Plethysmography for determination of lung volumes and, when performed, airway resistance

94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes

94728 Airway resistance by oscillometry

+94729 Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)

Lung volumes in codes 94726 and 94727 are lung volumes calculated using two different methods: plethysmography (body box) and gas dilution (nitrogen washout or helium dilution).

Pulmonary function testing of the lungs volume, airway resistance, and diffusing capacity is performed in multiple ways. For CPT code 94726, the lung volume and possibly the airway resistance are evaluated using a variety of methods. In the oldest method, the patient is enclosed in a pressurized small room and the volume of air and air resistance are measured as the patient breathes. In a newer method, two belts with sensors are wrapped around the patient at the rib cage and the abdomen to measure the lung volumes, referred to as respiratory inductance plethysmography.

In CPT code 94727, lung volumes are tested in a pulmonary lab using helium, nitrogen open circuit, or another method to check lung functions to include residual capacity or residual volume, the volume of air remaining in the lung after a patient exhales. The physician interprets the results. This code applies to the distribution of inspired gas using multiple breath nitrogen washout curves and including alveolar nitrogen or helium equilibration time.

In CPT code 94728, airway resistance is tested by oscillometry. In one method, the patient breathes into an apparatus called a pneumotachograph. This device uses soundwaves to detect and analyze airway changes.

CPT code 94728 may be reported in addition to gas dilution techniques. In 94729, diffusing capacity is tested. In this test, the patient takes a deep breath, holds it for 10 seconds, and releases the first half. The second half is collected and analyzed for the amount of carbon dioxide it contains

Measurement of lung volumes may be performed using plethysmography, helium dilution or nitrogen washout. Plethysmography (94726) is utilized to determine total lung capacity, residual volume, functional residual capacity, and airway resistance. Nitrogen washout or helium dilution (94727) may be used to measure lung volumes, distribution of ventilation and closing volume. Oscillometry (94728) assesses airway resistance and may be reported in addition to gas dilution techniques. Spirometry (94010, 94060) and bronchial provocation (94070) are not included in 94726 and 94727 and may be reported separately.

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