Surgical and diagnostic lung care coding optimized for pulmonologists
Pulmonology billing requires precise coding for pulmonary function tests (PFT), bronchoscopies, sleep studies, and CPAP compliance. VOPSS ensures your practice receives full reimbursement across all encounters.
Clean Claim Rate
99%
Coding Accuracy
99%
Days in A/R
<23
Denial Rate
<2%
Why pulmonology practices need specialized billing support
Pulmonology combines complex office consultations for chronic lung diseases (COPD, asthma, pulmonary fibrosis) with a wide array of diagnostic testing and invasive procedures. PFT coding is highly detailed, requiring precise combination coding for spirometry, lung volumes, and diffusion capacity testing. Additionally, invasive procedures like bronchoscopies and thoracentesis require precise modifier usage and global surgery management.
VOPSS provides dedicated pulmonology billing specialists who understand the complex rules governing respiratory CPT codes (94000 series), diagnostic testing, and sleep studies. Our team coordinates with your clinic to track technical and professional splits, manage prior authorizations for biological asthma treatments, and ensure all procedure claims are coded to the highest level of specificity.
Common pulmonology billing errors that impact collections
A frequent source of denials and underpayments in pulmonology is the incorrect billing of diagnostic PFTs performed on the same day as an E/M visit. Payers routinely deny the E/M portion if documentation does not show a separately identifiable clinical evaluation, requiring modifier 25. Another common error is failing to separately bill for PFT components (e.g., CPT 94010 for spirometry, 94726 for plethysmography).
Surgical coding errors also occur during bronchoscopies. CPT codes for bronchoscopies vary based on the specific tools and techniques used (e.g., biopsy, washings, brushings, stenting). Selecting the wrong code or failing to apply modifiers like modifier 51 (multiple procedures) results in significant underpayment. Prior authorization failures for sleep studies and biologic drugs also lead to regular non-coverage denials.
How VOPSS optimizes pulmonology billing
We provide comprehensive respiratory billing solutions that eliminate modifier errors and optimize surgical reimbursements.
PFT Coding Precision
Expert coding for spirometry, lung volumes, and diffusion capacity with correct component bundling.
Bronchoscopy Billing Compliance
Correct CPT coding for diagnostic and therapeutic bronchoscopies with proper technique matching.
Sleep Study Systems
Accurate billing for home and lab-based sleep testing with correct age and titration modifiers.
Biologic Drug Billing
Precise J-code billing for asthma biologics (Xolair, Nucala, Fasenra) with proper administration coding.
Oxygen & CPAP Compliance
Ensuring all compliance documentation for CPAP/BiPAP and home oxygen is met before claim submission.
Prior Authorization Management
Complete pre-authorization handling for sleep studies, bronchoscopies, and advanced biologic therapies.
Pulmonology Claim Scrubbing & LCD Alignment
Claims for pulmonology encounters are validated against Medicare NCCI edits, Local Coverage Determinations (LCDs), modifier pairing rules, and prior authorization records prior to ANSI 837P transmission.
Native EHR Access & 48-Hour Denial Triage
Our AAPC-certified specialists work inside your existing EHR/PM platform—Epic, Athenahealth, eClinicalWorks, NextGen, ModMed, or AdvancedMD—and appeal unpaid pulmonology claims within 48 hours.
Reducing PFT denials and increasing clinical collections by 22%
A pulmonology group was losing revenue due to missed PFT components, incorrect E/M coding, and frequent sleep study denials. VOPSS audited their billing history, updated their PFT templates, and corrected diagnostic code selection.
Clean Claim Rate
86% → 99.2%
Average Days in A/R
44 → 21 Days
Revenue Growth
+22.1%
Pulmonology Billing FAQs
How do you code a complete pulmonary function test?
A complete PFT typically includes spirometry (CPT 94010 or 94060 for pre/post bronchodilator), lung volumes by plethysmography (CPT 94726), and carbon monoxide diffusion capacity (CPT 94729). We ensure that these codes are billed together with the correct modifiers and that the documentation supports each testing component.
What CPT codes are used for bronchoscopies?
Bronchoscopy coding uses CPT 31622 for a diagnostic bronchoscopy. If additional procedures are performed, add-on or alternative codes must be used, such as CPT 31623 for brushings, 31624 for bronchial alveolar lavage (BAL), or 31625 for bronchial biopsies. We select the correct code based on the operative report.
How do you handle CPAP compliance billing?
CPAP compliance billing requires verifying that the patient has met the Medicare compliance criteria (using the device for at least 4 hours per night for 70% of nights during a consecutive 30-day period within the first 90 days of therapy). We ensure that the compliance report is documented in the medical record before submitting ongoing rental claims.
Do you support billing for sleep studies?
Yes, polysomnography is coded using CPT 95810 (sleep study with recording) or 95811 (sleep study with initiation of CPAP/BiPAP). Home sleep tests use HCPCS codes G0398-G0400. We ensure correct code selection based on parameters recorded and titration status.
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Ready to optimize your pulmonology billing?
Request a free pulmonology billing audit. We will review your claims, identify coding errors, and show you exactly where revenue is being lost.