Section C - The following ICD-10-CM codes are covered for CPT codes 94013, 94450, 94617, 94618, 94619, 94621, 94640, 94664, 94680, 94681, 94690, 94726, 94727, 94728 and 94729. For the utilization of CPT code 94664, see the Pulmonary Function Testing codes in the Article Text section above. Group 3 Codes
Abnormal lung function testing; Lung function testing abnormal; Reduced ventilatory capacity; Reduced vital capacity ICD-10-CM Diagnosis Code R94.2 …
Oct 01, 2021 · Z13.83 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z13.83 became effective on October 1, 2021. This is the American ICD-10-CM version of Z13.83 - other international versions of ICD-10 Z13.83 may differ. Type 1 Excludes.
Oct 01, 2021 · Abnormal results of pulmonary function studies. 2016 2017 2018 2019 2020 2021 2022 Billable/Specific Code. R94.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM R94.2 became effective on October 1, 2021.
Procedure | CPT Code |
---|---|
Pulmonary Function Testing—no bronchodilator | 94010 |
Pulmonary Function Testing pre and post bronchodilator | 94060 |
Aerosol treatment (includes demonstration)* | 94640 |
Demonstration | 94664 |
Encounter for screening for respiratory disorder NEC 1 Z13.83 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 The 2021 edition of ICD-10-CM Z13.83 became effective on October 1, 2020. 3 This is the American ICD-10-CM version of Z13.83 - other international versions of ICD-10 Z13.83 may differ.
The 2022 edition of ICD-10-CM Z13.83 became effective on October 1, 2021.
Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease. Type 1 Excludes. encounter for diagnostic examination-code to sign or symptom. Encounter for screening for other diseases and disorders.
Treatment for the following ICD-10 codes may require treatments up to four times per year: J84.10, J84.170, J84.178, J84.89 or J84.112. Refer to the related LCD for information regarding services for these diagnoses.
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 article, 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 article should be assumed to apply equally to all Revenue Codes.
Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Detect the presence or absence of lung dysfunction suggested by other abnormal diagnostic tests (e.g., radiography, arterial blood gas analysis).
The simple pulmonary stress testing is a test that allows quantification of workload and heart rate activity, while measuring the degree of oxygen desaturation. This test is undertaken to measure the degree of hypoxemia or desaturation that occurs with exertion. It is also used to optimize titration of supplemental oxygen for the correction of hypoxemia.
Post-bronchodilator spirometry is used to evaluate the reversible component of bronchospasm and to determine if the patient is a bronchodilator therapy candidate. Claims for spirometry will be subject to medical review as follows: there are clinical signs and symptoms consistent with bronchospasm; or spirometry without bronchodilator is abnormal; or reversibility or nonreversibility of bronchospasm has not been demonstrated. Repeat studies are covered only with clinically significant change, necessitating adjustment/augmentation of therapy, appropriately documented.
General clinical contraindications to spirometry include: hemoptysis of unknown origin, pneumothorax, unstable cardiovascular status, thoracic/abdominal or cerebral aneurysms, recent eye surgery, recent thoracic or abdominal surgery, and presence of acute disease processes that interfere with test performance.
Medicare does not cover screening tests. Medicare coverage excludes routine (screening) tests for asymptomatic patients with or without high risk of lung disease (e.g., prolonged smoking history). It also excludes studies as part of a routine exam, and studies as part of an epidemiological survey.
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Spirometry makes up the most commonly applied section of Pulmonary Function Testing (PFT). General indications are:
The evaluation of lung function is indicated to determine: The presence of lung disease or abnormality of lung function. The extent of abnormalities and the potential causative disease process. The extent of disability due to abnormal lung function. The progression of the disease.
Limitations: Post-bronchodilator spirometry is used to rule out a reversible component to a patient’s bronchospasm and determine if the patient is a candidate for bronchodilator therapy.
Diffusion capacity (DLCO) measurement is often indicated when spirometry and lung volume studies reveal restrictive disease. DLCO is used to help distinguish between an intrinsic pulmonary process, such as interstitial lung disease and emphysema, and an extrapulmonary process, such as chest wall and neuromuscular disorders. Diffusion capacity is also useful in quantifying the degree of parenchymal destruction in COPD, and assessing pulmonary vascular diseases and interstitial diseases, even if vital capacity is normal.
Spirometry studies, in particular, require a minimum of three attempts that must meet minimum acceptability criteria.
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. Lung compliance may be increased in emphysema and reduced in interstitial lung disease.
If reversibility of bronchospasm (bronchodilator responsiveness) has already been either ruled out or demonstrated, repeat pre- and post-bronchodilator study (94060) will be covered only when there is a significant clinical change in the patient’s functional respiratory status necessitating an adjustment or augmentation of bronchoactive medications, and this is documented in the patient’s medical record.