Pulmonology Billing Services

Pulmonology billing spans office visits, breathing tests, sleep studies, bronchoscopies, and critical care, and each of those service families has its own coding traps. A pulmonary function test without a signed interpretation, a sleep study billed with the wrong code family for the payer, or a spirometry code stacked on top of a code that already includes it can each turn a completed service into a denial. The work is rarely about one big rule; it is about getting a dozen small rules right on every claim.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for pulmonology practices, built around the tests and procedures pulmonologists actually perform.

Pulmonology billing challenges

Pulmonary function testing is one of the most common denial sources in the specialty. Spirometry is billed with 94010, while spirometry with a pre and post bronchodilator assessment is billed with 94060, and the two should not be billed together for the same encounter because 94060 already includes the baseline maneuver. Diffusion capacity testing is billed with 94729, and a complete pulmonary function assessment typically reports spirometry, lung volumes, and diffusing capacity together, with component codes such as vital capacity excluded because they are part of the spirometry service. Every pulmonary function code also requires a signed physician interpretation and report describing the pattern, severity, and comparison to prior studies where available. A tracing in the chart without that narrative is not supportable on audit and commonly denies for missing information.
Sleep medicine adds a payer split that catches many practices. In-lab polysomnography uses the CPT family that includes 95810 and 95811, with 95811 covering studies that include CPAP or bilevel titration. Home sleep apnea testing is different: Medicare requires HCPCS codes G0398, G0399, or G0400 selected by the type of portable monitor used, while commercial payers generally use CPT codes 95800, 95801, or 95806. Sending the commercial CPT codes to Medicare for a home study triggers an automatic denial. Most payers also require prior authorization for sleep studies and for CPAP equipment, and device and authorization mismatches are a separate denial path from coding errors.
Bronchoscopy, inhaler and nebulizer instruction, six minute walk testing, and critical care round out the mix, each with its own bundling edits. Several pulmonology procedures are subject to National Correct Coding Initiative bundling edits, so services that look separately billable on the schedule may bundle unless a modifier proves they were genuinely distinct.

What MedPlus RCM handles for pulmonology practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.

We serve pulmonology practices nationwide, including sleep medicine programs, pulmonary function labs, and critical care groups, across asthma, COPD, sleep apnea, interstitial lung disease, and pulmonary hypertension.

Results pulmonology practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Can we bill 94010 and 94060 on the same day?
No. Code 94060 already includes baseline spirometry plus a second set of maneuvers after bronchodilator administration, so it supersedes 94010 for that encounter. Billing both is treated as a duplicate service.
Why do our pulmonary function claims deny when the test was done correctly?
The most common reason is a missing or incomplete physician interpretation and report. Every pulmonary function code requires a signed interpretive statement, and a tracing without that narrative will deny or be recouped on audit.
How should home sleep studies be billed to Medicare?
Medicare requires HCPCS codes G0398, G0399, or G0400 for home sleep apnea tests, chosen by monitor type. The commercial CPT codes for home studies are not recognized for this purpose on a Medicare claim.
Do sleep studies need prior authorization?
Most payers require it, for both the study and for CPAP equipment. Authorization should be confirmed before the study is scheduled, and the authorized device type should match the test performed.
What does MedPlus RCM check before submitting a pulmonology claim?
Interpretation reports, code bundling, payer specific sleep study code families, and authorization status, so the common denial patterns are caught before submission rather than after.

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Find out where your pulmonology practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
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