Reporting Update for Pulmonary Function Testing and Pulmonary Rehabilitation

There is a significant number of recent changes that directly impact reporting for procedures, such as pulmonary function testing (PFT) and pulmonary rehabilitation. Relevant current changes include the addition of Category III tracking codes, 0243T and 0244T. These codes are to be reported for administering acoustic PFTs, which as the name implies, are codes gathered by payers to track the utilization of new technologies not currently reimbursable. Category II codes are used to report performance measures that are reported in addition to the usual CPT® Category I code. The reporting of these codes is required to qualify for PQRS incentive payments from Centers for Medicare & Medicaid Services. Pulmonary performance measure 51 is specifically to be used along with spirometry evaluation codes (94010, 94375, or 94060) for patients aged 18 years and older with a diagnosis of COPD who had spirometry results documented. The additional CPT® Category II code reported is 3023F “Spirometry results documented and reviewed.”

Pulmonary rehabilitation, the standard of care for treatment of COPD, is clearly now ready for prime time. Medicare coverage for this important therapy is now available to all qualifying beneficiaries. A notification mailed to all Medicare beneficiaries clearly indicates coverage for comprehensive pulmonary rehabilitation (HCPCS G0424) for moderate to very severe COPD (Medicare and You. 2011; 41). Recently, the approved diagnosis list has been expanded beyond moderate to very severe COPD by Highmark Medicare Services Local Coverage Determination (LCD) L31483. Effective for services performed on or after March 22, 2011, the expanded diagnosis includes cystic fibrosis (277.00), asthma (493.10-493.91), bronchiectasis (493.10- 493.91), and a variety of other diagnoses. It is anticipated that other Medicare Administrative Contractors (MAC) will emulate the Highmark LCD.

Sam Birnbaum, CMPE
Steering Committee Member