Heed pulmonary-testing code updates to trim denials, capture reimbursement

Why This Topic Matters

Pulmonary testing claims are vulnerable to denials when diagnosis support, bundling rules, and modifier reporting are not aligned with current coding guidance. Understanding the scope of these updates helps practices reduce avoidable claim rejections and improve payment accuracy.

Article Sections

1. Pulmonary testing coding updates

   Introduces recent guidance affecting common respiratory testing and inhalation treatment reporting. The section frames the overall denial and reimbursement issues addressed in the article.

2. Avoid above-average denial rates

   Discusses denial patterns, payer review concerns, and the role of diagnosis support for pulmonary testing claims. It also addresses the impact of ICD-10-CM selection and local coverage considerations.

3. Watch bundled codes with 94010

   Covers bundling concerns involving spirometry and related respiratory function tests. The section explains which broad service groupings are affected by reporting restrictions.

4. Be careful on your 94640 frequency

   Summarizes frequency-related reporting concerns for inhalation treatment claims and the circumstances that may require repeat-service reporting conventions. It also introduces modifier use in this context.

5. Use modifier 26 when the equipment is not your own

   Explains the general professional-component reporting context when equipment ownership differs from the provider’s setting. The section focuses on how billing arrangements can affect claim submission.