Pulmonology Billing Services
Pulmonology practices bill for both thinking and testing. Office visits manage asthma, COPD, and lung disease over time, while pulmonary function tests give the numbers behind each decision. Tests are often billed in combinations, such as spirometry before and after a bronchodilator, with add-ons for lung volumes and diffusion.
Many pulmonologists also do bronchoscopy, manage sleep apnea, and cover the hospital or ICU. Each setting follows different coding rules. Westmont Revenue Partners connects pulmonology practices with vetted billing experts who understand pulmonology billing, including test bundling and procedure documentation.
Who this is for
- Pulmonologists in private practice
- Pulmonary and critical care groups
- Practices with an in-house pulmonary function lab
- Groups that perform bronchoscopy in hospitals or ASCs
- Practices that diagnose and treat sleep apnea
- Nurse practitioners and physician assistants in pulmonology
What gets billed
- New and established patient visits
- Spirometry and bronchodilator response testing
- Lung volume and diffusion capacity testing
- Six-minute walk and exercise testing
- In-office nebulizer treatments
- Diagnostic bronchoscopy with washing or biopsy
- Starting CPAP or bilevel therapy
- Hospital consults and follow-up care
- Home oxygen evaluation and documentation
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99214 | CPT | Established patient office visit at a moderate level |
| 94010 | CPT | Spirometry measuring breathing volume and flow |
| 94060 | CPT | Spirometry before and after a bronchodilator |
| 94726 | CPT | Body plethysmography for lung volumes |
| 94729 | CPT | Add-on for lung diffusing capacity |
| 94618 | CPT | Pulmonary stress testing such as a walk test |
| 94640 | CPT | Nebulizer treatment for airway obstruction |
| 94660 | CPT | Starting CPAP or similar ventilation support |
| 31622 | CPT | Diagnostic bronchoscopy with washing |
| 31624 | CPT | Bronchoscopy with bronchial alveolar lavage |
| 31628 | CPT | Bronchoscopy with lung biopsy |
| J44.9 | ICD-10-CM | Chronic obstructive pulmonary disease, unspecified |
| G47.33 | ICD-10-CM | Obstructive sleep apnea |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in pulmonology
Combining lung function tests. Spirometry, lung volumes, and diffusion are often done together, and some combinations bundle. A biller checks the test list against bundling edits and payer policy.
Bronchoscopy code selection. Bronchoscopy codes depend on what was done at each site, such as washing, lavage, or biopsy. A biller reads the procedure note carefully and applies the right code and modifiers.
Same-day visit and testing. An office visit billed with testing may need a modifier and a separate, clear note. A biller checks payer rules before adding one.
Documenting medical necessity. Tests need diagnoses and symptoms that support them. A biller works with staff so the note links each test to a reason.
Sleep apnea and equipment. Starting CPAP involves testing, visits, and device supplier rules. A biller coordinates documentation so each party can bill properly.
Home oxygen documentation. Oxygen coverage often needs saturation results and a qualifying diagnosis. A biller makes sure required records are in the chart.
Critical care and hospital billing. Pulmonologists who cover the ICU face time-based coding rules. A biller reviews notes so time and overlapping services are supported.
How Westmont can help
- Matching you with vetted billing experts experienced in pulmonology
- End-to-end revenue cycle support for office, testing, and procedure claims
- Denial management for bundling and medical necessity issues
- Credentialing support for new pulmonologists and hospital privileges
- Reporting by test type and payer
Frequently asked questions
Can pulmonary function tests be billed together?
Often yes, but some combinations bundle and some are add-ons to others. Spirometry, lung volumes, and diffusion capacity each have their own rules, and payers apply edits. Documentation should show which tests were done and why. A biller checks the list against current edits before submitting.
How is bronchoscopy billed?
Codes depend on what was performed during the procedure, such as washing, lavage, or biopsy. Multiple actions in one session may be bundled under a single code or reported separately, depending on rules. The operative note should be detailed. A biller reviews it before choosing codes.
What is needed to bill for a six-minute walk test?
Payers generally look for a qualifying diagnosis, a clear order, and documented results such as distance and oxygen levels. Policies vary by payer. A biller confirms current requirements and helps staff capture the needed details.
Why do pulmonology claims get denied?
Common causes include bundled tests, missing modifiers, a diagnosis that does not support the test, and missing authorization for procedures. A biller checks these before the claim goes out and follows up on denials.
Should a pulmonology practice outsource billing?
It may help when testing volume and hospital coverage create a heavy workload. Westmont does not submit claims itself. We connect you with vetted billing experts, and you decide whether a match fits your practice.
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