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.

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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.

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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.

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.