Compare and Contrast 94620 and Its Replacement Codes for Pulmonary Testing

pulmonary testing

Pulmonology coders are saying goodbye to a common pulmonary stress testing code on Jan. 1, 2018. Here’s what’s replacing it, along with some Medicare Physician Fee Schedule details to help you get a better handle on the new codes.

Compare the Code Descriptors

In 2017, you use 94620 (Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)) for simple pulmonary stress testing.

For dates of service of Jan. 1, 2018, and later, you’ll use these two new codes instead of 94620:

  • 94617 (Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry)
  • 94618 (Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed).

What’s the Same? PC/TC

The recently released Medicare Physician Fee Schedule (MPFS) reveals that you can apply some of your knowledge about 94620 to new codes 94617 and 94618.

For instance, like 94620, codes 94617 and 94618 will be split into professional and technical components. That means that if you’re reporting only the professional component of the testing, you should append modifier 26 (Professional component). If you’re reporting only the technical component, you should append modifier TC (Technical component). To report both the professional and technical component, report the global code 94620 without 26 and TC.

What’s Different? Fees

One of the first questions many coders had when they saw the new codes was whether the change would affect payment. Based on the 2018 MPFS files, the answer is yes, with some ups and downs.

2017: The total RVUs for global 94620 in the fourth quarter of 2017 equal 1.59. Multiply that by the conversion factor of 35.8887, and you get roughly $57.06.

2018: For 94617, the recently released 2018 MPFS files show 2.7 total RVUs and a conversion factor of 35.9996, coming to about $97.20.

For 94618, which is testing like the 6-minute walk test, the total RVUs are lower at 0.97. Multiplied by the conversion factor, that equals about $34.92.

Don’t forget: If you’re reporting only one of the components (professional or technical), your payment will be lower than if you perform and report the global code.

Check out how the total RVUs differ for the components:

  • 94617              2.7
  • 94617-TC        1.75
  • 94617-26         0.95

 

  • 94618              0.97
  • 94618-TC        0.32
  • 94618-26         0.65

What About You?

Do you think the RVUs accurately reflect the professional and technical components required for each test? Does it make sense to you to split 94620 into more specific codes?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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