The information in this quick guide is provided by our Healthcare Economics Department, which supplies coding, coverage and payment information for Nellcor and Puritan Bennett" products. If you have questions or would like additional information, please call 1-800-645-2891.
Who should have spirometry testing?
In 1994, the American Thoracic Society published an official statement of "Standardization of Spirometry". In this statement, they list some of the potential indications for spirometry. (Some of the listed indications for spirometry may not be covered by Medicare or other insurers.)
- To assess therapeutic interventions (bronchodilator therapy, steroid treatment, management of CHF, etc.)
- To assess preoperative risk
- To screen individuals at risk of having pulmonary diseases (smokers, occupational exposure)*
- To assess health status before enrollment in strenuous physical activity programs*
- To assess patients as part of a rehabilitation program
- To assess risks as part of an insurance evaluation*
- To assess individuals for legal reasons (Social Security, personal injury lawsuits)*
*These indications are not generally covered by Medicare
What codes describe spirometry
procedures?
The Current Procedural Terminology (CPT) codes defined below are usually used to describe spirometry procedures performed with the Renaissance® II Spirometry System and Simplicity™ Spirometry System. The Simplicity system will not perform a respiratory flow volume loop (CPT code 94375).
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Spirometry Procedures Unadjusted
CPT Code and 2002 Medicare
Description(1)* Allowable (2)*
94010 - Breathing capacity test .......$36
94060 - Evaluation of wheezing
(pre- & post- bronchodilator ...........$62
94375 - Respiratory flow
volume loop .....................................$29
*Most commonly used CPT codes for spirometry
Additional codes may be found in the 2002 Current Procedural Terminology (CPT) Manual, published by the American Medical Association. All spirometers may not perform all procedures identified by CPT Codes.
**Actual Medicare allowables vary by geographic region.
What documentation is needed to support payment for spirometry procedures?
Many Medicare Part B carriers have published Local Medical Review Policies (LMRP), which describe specific coverage guidelines for spirometry procedures. Empire Medicare (4) offers the following list of ICD-9 codes which may help to support the medical necessity for spirometry testing. These codes may not be applicable in other regions of the country; for definitive coverage and payment information, contact your local Part B carrier or call our Health Care Economics Department at 1-800-645-2891 for a faxed copy of your
LMRP, if available.
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