Clinic, lab, procedure suite and ICU
Pulmonary and critical care physicians bill across very different settings: office visits for asthma, COPD and interstitial lung disease; a pulmonary function lab; bronchoscopy in the procedure suite; and time-based critical care in the ICU. Each setting has its own coding logic, and the professional and technical parts of testing are often split between the practice and a hospital.
Pulmonary function testing
| Test | Codes | Watch for |
|---|---|---|
| Spirometry; before and after bronchodilator | 94010; 94060 | 94060 includes the spirometry — not billed together |
| Lung volumes | 94726 (plethysmography) or 94727 (gas dilution) | Method documented |
| Diffusing capacity | 94729 (add-on) | Reported with its primary test |
| Six-minute walk / exercise testing | 94618 and other exercise codes | Oximetry often bundled |
When the test is performed in a hospital lab and the physician only interprets it, the professional component (modifier 26) is billed; a practice that owns the equipment bills the global service. Each test needs an order, a report and a supporting diagnosis.
Bronchoscopy and EBUS
- Diagnostic bronchoscopy (31622) is included in any surgical bronchoscopy performed at the same session.
- Sampling procedures — lavage (31624), endobronchial biopsy (31625), transbronchial biopsy (31628, with 31632 for each additional lobe) — are coded for each distinct technique.
- EBUS: linear EBUS sampling is coded by the number of nodal stations (31652 for one or two, 31653 for three or more); radial EBUS (31654) and navigation (31627) are add-ons.
- Moderate sedation by the bronchoscopist is reported separately (99152, 99153) where the payer allows, with the time documented.
Critical care and hospital work
Critical care is billed by total time spent on the patient’s critical illness: 99291 for the first 30–74 minutes and 99292 for each additional 30 minutes, excluding separately billed procedures. The note must record the time and the critical condition. Medicare has specific rules when critical care and another E/M visit happen on the same day, or when several practitioners of the same specialty share the care.
Rehabilitation, oxygen and chronic disease
Pulmonary rehabilitation is billed per session with 94625 or 94626 (with continuous oximetry), and Medicare limits both the qualifying diagnoses and the number of sessions. Home oxygen is billed by the equipment supplier, but its coverage depends on the physician’s documentation of qualifying test results and need. Inhaled specialty drugs and biologics for severe asthma usually need prior authorization.