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L28974 PULMONARY DIAGNOSTIC SERVICES
01/01/2012
Indications and Limitations of Coverage and/or Medical Necessity
Medicare will consider pulmonary diagnostic tests medically necessary for the indications outlined below.
(It is expected the provider of services will follow a thoughtful, purposeful sequence in his/her selection of tests appropriate to the patient’s presenting complaint, medical history, physical examination, etc.)
Indications
• Pulmonary diagnostic services will be considered reasonable and medically necessary when
o Ordered by the patient’s treating physician for a specific medical problem.
And
o When performed only by providers of pulmonary services or other providers who have specialized training and expertise in performing pulmonary diagnostic services.
• The CMS Manual System, Pub. 100-08, Program Integrity Manual, Chapter 13, Section 5.1 (http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf outlines that “reasonable and necessary" services are "ordered and/or furnished by qualified personnel."
o A qualified physician for this service/procedure is defined as follows:
Physician is properly enrolled in Medicare.
Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty in the United States or must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States.
• All pulmonary diagnostic studies must be:
o Performed by a qualified physician.
o Performed under the general supervision of a qualified physician by a technologist who has demonstrated minimum entry level competency by being credentialed by a recognized national credentialing body such as the National Board for Respiratory Care (NBRC).
In addition to receiving credentialing by a recognized national credentialing body, qualified technologists must have a state license.
• Examples of certification for pulmonary diagnostic testing by non-physician personnel include:
o Certified Pulmonary Function Technician (CPFT).
o Registered Pulmonary Function Technician (RPFT).
o Certified Respiratory Therapist (CRT).
o Registered Respiratory Therapist (RRT).
o Perinatal/Pediatric Care Specialist.
• In addition to credentialing requirements, a state license is required if mandated by the state/territory of the practicing clinician.
o In the absence of a state/territory licensing or credentialing process, documentation should be maintained by the supervising physician who demonstrates appropriate training of staff performing the services.
o This documentation should be available to Medicare upon request.
Limitations
• The use of pulmonary diagnostic function testing as part of the routine clinical exam is not covered under the Medicare benefit.
o In instances where studies are recommended as part of a preoperative evaluation in a patient with no active pulmonary symptoms, the record must document the rationale for the study (i.e.
Long history of smoking.
Asbestos exposure.
Exposure to toxic drugs.
o Studies performed in the absence of such documentation will be considered NOT reasonable and medically necessary.
• Patient initiated spirometry (94014, 94015 and 94016) is non-covered and will not be reimbursed.
Pulmonary Function Tests
• PFTs measure two components of the respiratory system: the mechanical ability of the respiratory system to move air in and out of the lungs; and the effectiveness of the respiratory system in exchanging oxygen and carbon dioxide with the atmosphere. A PFT includes three possible components:
o Spirometry (94010, 94060, 94070).
o Lung Volume Determination (94250, 94726, 94727 and 94728).
Lung Volume tests cannot be measured directly using Spirometry because these volumes and capacities include air that cannot be expelled from the lungs.
Lung Volume is generally determined in one of four ways:
• Closed circuit helium equilibration.
• Open circuit nitrogen washout.
• Whole body plethysmography.
• Radiologic techniques.
o Diffusion Capacity Tests (94729).
• The PFT will be considered medically necessary for the following conditions:
• Preoperative evaluation of the lungs and pulmonary reserve when:
o Thoracic surgery will result in loss of functional pulmonary tissue. (i.e., lobectomy).
o Patients are undergoing major thoracic and/or abdominal surgery and the physician has some reason to believe the patient may have a pre-existing pulmonary limitation (e.g., long history of smoking).
o The patient’s pulmonary function is already severely compromised by other diseases such as chronic obstructive pulmonary disease (COPD).
• Initial diagnostic workup for the purpose of differentiating between obstructive and restrictive forms of chronic pulmonary disease.
o Obstructive defects (e.g., emphysema, bronchitis, asthma) occur when ventilation is disturbed by an increase in airway resistance.
o Expiration is primarily affected.
o Restrictive defects (e.g., pulmonary fibrosis, tumors, chest wall trauma) occur when ventilation is disturbed by a limitation in chest expansion. Inspiration is primarily affected.
To assess the indications for and effect of therapy in diseases such as sarcoidosis, diffuse lupus erythematosus, and diffuse interstitial fibrosis syndrome.
Evaluate patient’s response to a newly established bronchodilator anti-inflammatory therapy.
To monitor the course of asthma and the patient’s response to therapy.
• (i.e., especially to confirm home peak expiratory flow measurements).
Evaluate patients who continue to exhibit increasing shortness of breath (SOB) after initiation of bronchodilator anti-inflammatory therapy.
Initial evaluation for a patient that presents with new onset (within 1 month) of one or more of the following symptoms: shortness of breath, cough, dyspnea, wheezing, orthopnea, or chest pain.
Initial diagnostic workup for a patient whose physical exam revealed one of the following: overinflation, expiratory slowing, cyanosis, chest deformity, wheezing, or unexplained crackles.
Initial diagnostic workup for a patient with chronic cough.
• It is not expected that a patient would have a repeat spirometry without new symptomatology.
• Re-evaluation of a patient with or without underlying lung disease who presents with increasing SOB (from previous evaluation) or worsening cough and related qualifying factors such as abnormal breath sounds or decreasing endurance to perform Activities of Daily Living (ADL’s).
o To establish baseline values for patients being treated with pulmonary toxic regimens (e.g., Amiodarone).
o To monitor patients being treated with pulmonary toxic regimens when any new respiratory symptoms (e.g., exertional dyspnea, non-productive cough, pleuritic chest pain) may suggest the possibility of pulmonary toxicity.
o To evaluate cystic fibrosis patients with pulmonary manifestations.
• It is expected that procedure code 94070 will only be performed to make an initial diagnosis of asthma.
• Also, it is expected that procedure code 94060 be utilized during the initial diagnostic evaluation of a patient.
o Once it has been determined that a patient is sensitive to bronchodilators, repeat bronchospasm evaluation is usually not medically necessary, unless one of the following circumstances exist:
A patient is exhibiting an acute exacerbation and a bronchospasm evaluation is being performed to determine if the patient will respond to bronchodilators.
The initial bronchospasm evaluation was negative for bronchodilator sensivity and the patient presents with new symptoms which suggest the patient has a disease process which may respond to bronchodilators.
The initial bronchospasm evaluation was not diagnostic due to lack of patient effort. Repeat spirometries performed to evaluate patients’ response to newly established treatments, monitor the course of asthma/COPD, or evaluate patients continuing with symptomatology after initiation of treatment should be utilized with procedure code 94010.
• In addition, it is not expected that a pulse oximetry (procedure code 94760 or 94761) for oxygen saturation would routinely be performed with spirometry.
o Pulse oximetry is considered medically necessary when the patient has a condition resulting in hypoxemia and there is a need to assess the status of a chronic respiratory condition, supplemental oxygen and/or a therapeutic regimen. (e.g., acute symptoms).
• Usually during an initial evaluation, there is no reason to obtain a spirometry after the administration of bronchodilators in patients who have normal spirometry, normal flow volume loop and normal airway resistance unless there is reason to believe (e.g., symptoms, exam) that a patient has underlying lung disease.
• The residual volume (RV) cannot be measured by spirometry because this includes air that cannot be expelled from the lungs, and, therefore, is determined by subtracting the expiratory reserve volume (ERV) from the functional residual capacity (FRC).
o The FRC cannot be measured by simple spirometry either.
o Therefore, procedure code 94726 or 94727 will be performed when the RV and FRC need to be determined.
• The Maximum Voluntary Ventilation (MVV; procedure code 94200) is a determination of the liters of air that a person can breathe per minute by a maximum voluntary effort.
o This test measures several physiologic phenomena occurring at the same time.
o The results and success of this test are effort dependent, therefore, routine performance of this test is not recommended, except in cases such as:
Pre-operative evaluation.
Neuromuscular weakness.
Upper airway obstruction.
Suspicion of Chest Bellows disease.
• The Respiratory Flow Volume Loop (procedure code 94375) is used to evaluate the dynamics of both large and medium size airways.
o This test is more useful than the conventional spirogram.
o The procedure is the same for spirometry except for the addition of a maximal forced inspiration at the end of the force expiratory measures.
Pulmonary Stress Testing (94620, 94621)
• The pulmonary stress testing procedures range from simple to complex.
o The simple procedure (Stage 1) consists of BP, ECG, and ventilation measurements at timed increments during exercise.
o The complex procedure includes Stage 2 and Stage 3. Stage 2 involves all of Stage 1 measurements in addition to the mixed venous CO2 tension (production) by means of rebreathing technique and O2 uptake.
o Stage 3 requires the following:
Blood gas sampling and analysis.
An indwelling catheter is inserted into the brachial or radial artery.
In addition to Stage 2 tests, measurements for cardiac output, alveolar ventilation, ratio of dead space to tidal volume, alveolar-arterial O2 tension difference, venous admixture ratio and lactate levels are determined.
• Exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions.
o The Pulmonary Stress Test will be considered medically necessary for the following conditions:
To determine whether the patient’s exercise intolerance is related to pulmonary disease, cardiac disease, or due to lack of conditioning or poor effort.
Initial diagnostic workup when symptoms (generally dyspnea) are out of proportion to findings on static function (spirometry, lung volume, diffusion capacity).
Detection of interstitial lung disease (fibrosis) or exercise-induced broncho-spasm which are only manifested by exercise.
Evaluate patient’s response to a newly established pulmonary treatment regimen.
• The majority of clinical problems can be assessed during the simple procedures included in Stage 1, and should be completed before more complex tests are performed.
o Abnormal results indicate that more precise information is required through more complex Stage 2 protocols.
o If Stage 3 protocols are implemented, arterial blood analysis is necessary. In 75% of patients, Stage 1 is sufficient.
o Oxygen titration can be done during graded exercise to determine the oxygen needs for improving exercise tolerance and increased functional capacity.
• Absolute contraindications to exercise testing include:
o Acute febrile illness.
o Pulmonary edema.
o Systolic BP > 250mm Hg.
o Diastolic BP > 120mm Hg.
o Acute asthma attack.
o Unstable angina.
o Acute Myocarditis.
Lung Compliance (94750)
• Lung compliance measures the elastic recoil or stiffness of the lungs.
o It is more invasive than other PFTs, because the patient is required to swallow an esophageal balloon.
• Compliance studies are performed only when all other PFTs give equivocal results, or the results require confirmation by additional data.
Coding Information
Bill Type Codes
• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.
• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.
• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
13x Hospital Outpatient
14x Hospital - Laboratory Services Provided to Non-patients
21x Skilled Nursing - Inpatient (Including Medicare Part A)
22x Skilled Nursing - Inpatient (Medicare Part B only)
23x Skilled Nursing - Outpatient
85x Critical Access Hospital
Revenue Codes
• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.
• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.
• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0460 Pulmonary Function - General Classification
0469 Pulmonary Function - Other Pulmonary
CPT/HCPCS Codes
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
94070 BRONCHOSPASM PROVOCATION EVALUATION, MULTIPLE SPIROMETRIC DETERMINATIONS AS IN 94010, WITH ADMINISTERED AGENTS (EG, ANTIGEN[S], COLD AIR, METHACHOLINE)
94200 MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION
94250 EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)
94375 RESPIRATORY FLOW VOLUME LOOP
94620 PULMONARY STRESS TESTING; SIMPLE (EG, 6-MINUTE WALK TEST, PROLONGED EXERCISE TEST FOR BRONCHOSPASM WITH PRE- AND POST-SPIROMETRY AND OXIMETRY)
94621 PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 UPTAKE, AND ELECTROCARDIOGRAPHIC RECORDINGS)
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 IMPULSE OSCILLOMETRY
94729 DIFFUSING CAPACITY (EG, CARBON MONOXIDE, MEMBRANE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
94750 PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND PRESSURE MEASUREMENTS)
ICD-9 Codes that Support Medical Necessity
135 SARCOIDOSIS
162.0 MALIGNANT NEOPLASM OF TRACHEA
162.2 MALIGNANT NEOPLASM OF MAIN BRONCHUS
162.3 MALIGNANT NEOPLASM OF UPPER LOBE BRONCHUS OR LUNG
162.4 MALIGNANT NEOPLASM OF MIDDLE LOBE BRONCHUS OR LUNG
162.5 MALIGNANT NEOPLASM OF LOWER LOBE BRONCHUS OR LUNG
162.8 MALIGNANT NEOPLASM OF OTHER PARTS OF BRONCHUS OR LUNG
162.9 MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.3 SECONDARY MALIGNANT NEOPLASM OF OTHER RESPIRATORY ORGANS
212.2 BENIGN NEOPLASM OF TRACHEA
212.3 BENIGN NEOPLASM OF BRONCHUS AND LUNG
231.2 CARCINOMA IN SITU OF BRONCHUS AND LUNG
277.02 CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS
415.0 ACUTE COR PULMONALE
415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION
415.12 SEPTIC PULMONARY EMBOLISM
415.13 SADDLE EMBOLUS OF PULMONARY ARTERY
415.19 OTHER PULMONARY EMBOLISM AND INFARCTION
446.20 HYPERSENSITIVITY ANGIITIS UNSPECIFIED
466.0 ACUTE BRONCHITIS
466.11 ACUTE BRONCHIOLITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS (RSV)
466.19 ACUTE BRONCIOLITIS DUE TO OTHER INFECTIOUS ORGANISMS
486 PNEUMONIA ORGANISM UNSPECIFIED
490 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC
491.0 SIMPLE CHRONIC BRONCHITIS
491.1 MUCOPURULENT CHRONIC BRONCHITIS
491.20 OBSTRUCTIVE CHRONIC BRONCHITIS WITHOUT EXACERBATION
491.21 OBSTRUCTIVE CHRONIC BRONCHITIS WITH (ACUTE) EXACERBATION
491.22 OBSTRUCTIVE CHRONIC BRONCHITIS WITH ACUTE BRONCHITIS
491.8 OTHER CHRONIC BRONCHITIS
491.9 UNSPECIFIED CHRONIC BRONCHITIS
492.0 EMPHYSEMATOUS BLEB
492.8 OTHER EMPHYSEMA
493.00 EXTRINSIC ASTHMA UNSPECIFIED
493.01 EXTRINSIC ASTHMA WITH STATUS ASTHMATICUS
493.02 EXTRINSIC ASTHMA WITH (ACUTE) EXACERBATION
493.10 INTRINSIC ASTHMA UNSPECIFIED
493.11 INTRINSIC ASTHMA WITH STATUS ASTHMATICUS
493.12 INTRINSIC ASTHMA WITH (ACUTE) EXACERBATION
493.20 CHRONIC OBSTRUCTIVE ASTHMA UNSPECIFIED
493.21 CHRONIC OBSTRUCTIVE ASTHMA WITH STATUS ASTHMATICUS
493.22 CHRONIC OBSTRUCTIVE ASTHMA WITH (ACUTE) EXACERBATION
493.81 EXERCISE-INDUCED BRONCHOSPASM
493.82 COUGH VARIANT ASTHMA
493.90 ASTHMA UNSPECIFIED
493.91 ASTHMA UNSPECIFIED TYPE WITH STATUS ASTHMATICUS
493.92 ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION
494.0 BRONCHIECTASIS WITHOUT ACUTE EXACERBATION
494.1 BRONCHIECTASIS WITH ACUTE EXACERBATION
495.0 FARMERS' LUNG
495.1 BAGASSOSIS
495.2 BIRD-FANCIERS' LUNG
495.3 SUBEROSIS
495.4 MALT WORKERS' LUNG
495.5 MUSHROOM WORKERS' LUNG
495.6 MAPLE BARK-STRIPPERS' LUNG
495.7 'VENTILATION' PNEUMONITIS
495.8 OTHER SPECIFIED ALLERGIC ALVEOLITIS AND PNEUMONITIS
495.9 UNSPECIFIED ALLERGIC ALVEOLITIS AND PNEUMONITIS
496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED
500 COAL WORKERS' PNEUMOCONIOSIS
501 ASBESTOSIS
502 PNEUMOCONIOSIS DUE TO OTHER SILICA OR SILICATES
503 PNEUMOCONIOSIS DUE TO OTHER INORGANIC DUST
504 PNEUMONOPATHY DUE TO INHALATION OF OTHER DUST
505 PNEUMOCONIOSIS UNSPECIFIED
506.4 CHRONIC RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS
506.9 UNSPECIFIED RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS
508.0 ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION
508.1 CHRONIC AND OTHER PULMONARY MANIFESTATIONS DUE TO RADIATION
508.2 RESPIRATORY CONDITIONS DUE TO SMOKE INHALATION
508.8 RESPIRATORY CONDITIONS DUE TO OTHER SPECIFIED EXTERNAL AGENTS
508.9 RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT
515 POSTINFLAMMATORY PULMONARY FIBROSIS
516.0 PULMONARY ALVEOLAR PROTEINOSIS
516.1 IDIOPATHIC PULMONARY HEMOSIDEROSIS
516.2 PULMONARY ALVEOLAR MICROLITHIASIS
516.30 IDIOPATHIC INTERSTITIAL PNEUMONIA, NOT OTHERWISE SPECIFIED
516.31 IDIOPATHIC PULMONARY FIBROSIS
516.32 IDIOPATHIC NON-SPECIFIC INTERSTITIAL PNEUMONITIS
516.33 ACUTE INTERSTITIAL PNEUMONITIS
516.34 RESPIRATORY BRONCHIOLITIS INTERSTITIAL LUNG DISEASE
516.35 IDIOPATHIC LYMPHOID INTERSTITIAL PNEUMONIA
516.36 CRYPTOGENIC ORGANIZING PNEUMONIA
516.37 DESQUAMATIVE INTERSTITIAL PNEUMONIA
516.4 LYMPHANGIOLEIOMYOMATOSIS
516.5 ADULT PULMONARY LANGERHANS CELL HISTIOCYTOSIS
516.8 OTHER SPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHIES
516.9 UNSPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHY
517.1 RHEUMATIC PNEUMONIA
517.2 LUNG INVOLVEMENT IN SYSTEMIC SCLEROSIS
517.3 ACUTE CHEST SYNDROME
517.8 LUNG INVOLVEMENT IN OTHER DISEASES CLASSIFIED ELSEWHERE
518.0 PULMONARY COLLAPSE
518.1 INTERSTITIAL EMPHYSEMA
518.2 COMPENSATORY EMPHYSEMA
518.3 PULMONARY EOSINOPHILIA
518.4 ACUTE EDEMA OF LUNG UNSPECIFIED
518.51 ACUTE RESPIRATORY FAILURE FOLLOWING TRAUMA AND SURGERY
518.52 OTHER PULMONARY INSUFFICIENCY, NOT ELSEWHERE CLASSIFIED, FOLLOWING TRAUMA AND SURGERY
518.53 ACUTE AND CHRONIC RESPIRATORY FAILURE FOLLOWING TRAUMA AND SURGERY
518.6 ALLERGIC BRONCHOPULMONARY ASPERGILLIOSIS
518.7 TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)
518.81 ACUTE RESPIRATORY FAILURE
518.82 OTHER PULMONARY INSUFFICIENCY NOT ELSEWHERE CLASSIFIED
518.83 CHRONIC RESPIRATORY FAILURE
518.84 ACUTE AND CHRONIC RESPIRATORY FAILURE
518.89 OTHER DISEASES OF LUNG NOT ELSEWHERE CLASSIFIED
519.11 ACUTE BRONCHOSPASM
519.19 OTHER DISEASES OF TRACHEA AND BRONCHUS
519.4 DISORDERS OF DIAPHRAGM
519.8 OTHER DISEASES OF RESPIRATORY SYSTEM NOT ELSEWHERE CLASSIFIED
780.51 INSOMNIA WITH SLEEP APNEA, UNSPECIFIED
780.53 HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED
780.57 UNSPECIFIED SLEEP APNEA
786.02 ORTHOPNEA
786.03 APNEA
786.04 CHEYNE-STOKES RESPIRATION
786.05 SHORTNESS OF BREATH
786.06 TACHYPNEA
786.07 WHEEZING
786.09 RESPIRATORY ABNORMALITY OTHER
786.2 COUGH
786.30 HEMOPTYSIS, UNSPECIFIED
786.39 OTHER HEMOPTYSIS
793.11 SOLITARY PULMONARY NODULE
793.19 OTHER NONSPECIFIC ABNORMAL FINDING OF LUNG FIELD
799.1 RESPIRATORY ARREST
V58.83 ENCOUNTER FOR THERAPEUTIC DRUG MONITORING
V72.82 PRE-OPERATIVE RESPIRATORY EXAMINATION
Documentation Requirements
• Medical record documentation must indicate the medical necessity for performing the test.
o In addition, documentation that the service was performed, including the results of the pulmonary diagnostic tests, should be available.
o This information is normally found in the office notes, progress notes, history and physical, and/or hard copy of the test results.
• If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.
o The physician must state the clinical indication/medical necessity for the study in his order for the test.
• Test results and interpretation must be correlated with the clinical presentation of the patient and documented in the medical records.
o The specific procedures performed must be used for decision making and not duplicative of information obtained.
o Therefore, documentation should support that the test results and interpretation were used for the treatment of a specific medical problem by the physician who ordered the services.
Utilization Guidelines
• The frequency of testing (repeat testing) must be related to the patient’s clinical status and correlated to the severity of a specific diagnosis.
Sources of Information and Basis for Decision
FCSO LCD FCSO 29265, Pulmonary Diagnostic Services, 01/01/2012. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.
Medical Encyclopedia: Pulmonary function tests. Retrieved 10/13/2003 from http://www.nlm.nih.gov/medlineplus/print/ency/article/003853.htm
Medicare Coverage Database
Murray and Nadel. (2000). Textbook of Respiratory Medicine (3rd ed.). W.B. Saunders Company.
AMA CPT / ADA CDT Copyright Statement
CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.