What makes pulmonology billing different
Our pulmonology billing services cover a practice that is really three businesses in one: an office managing COPD, asthma and interstitial disease, a procedure suite doing bronchoscopy and pulmonary function testing, and often a sleep program with its own authorization rules. Each lane bills different code families to different payer rules. Fastora's certified billing and coding professionals handle pulmonary claims as part of our wider medical billing services.
The common thread is medical necessity. Payers scrutinize breathing tests, sleep studies and inhalation drugs more closely than routine office work, so every order needs the symptom or diagnosis that justifies it. We run eligibility and benefits checks before testing and procedures, confirming coverage for the planned codes rather than discovering an exclusion after the patient has been tested.
Pulmonary function testing: codes and bundling
| Code | Descriptor (summary) | Billing note |
|---|---|---|
| 94010 | Spirometry, including graphic record | Base breathing test; add 94060 with bronchodilator |
| 94060 | Bronchodilation responsiveness, spirometry as in 94010 | Billed with 94010, never alone |
| 94375 | Respiratory flow volume loop | Component of fuller PFT workups |
| 94726 | Plethysmography, lung volumes | Often paired with diffusion capacity |
| 94640 | Inhalation treatment with pressurized or nonpressurized nebulizer | Per treatment session; drug billed separately |
| 94664 | Demonstration or evaluation of inhaler or nebulizer use | Education visit; report per technique taught |
Pulmonary function codes are component codes: reporting the full panel when only spirometry was done, or reporting 94060 without 94010, triggers edits. Interpretation and report are included in the testing codes, so a separate interpretation charge on the same day does not stand. Our coding team checks that the billed components match what the equipment report shows, and that the order lists the symptoms that make the test medically necessary.
Bronchoscopy and procedure billing
Diagnostic bronchoscopy, transbronchial biopsies and needle aspiration done in one session follow surgical packaging rules: the diagnostic scope is the base, and biopsy or aspiration codes report the additional work. Endobronchial ultrasound sampling has its own codes by the number of nodal stations sampled, reported as add-ons.
Bronchoscopy carries a global period, so related follow-up visits in the days after the procedure are part of the payment, not separately billable. We track global periods by patient and check that biopsies sent to pathology match the procedure billed, since a mismatch is a common audit flag.
Sleep studies: authorizations and coverage
Sleep studies are one of the most authorization-heavy parts of pulmonary billing. In-lab polysomnography and home sleep tests need approval from most commercial and Medicare Advantage plans, and the request has to document sleep apnea signs such as witnessed apneas, daytime sleepiness or resistant hypertension, plus why a home test is or is not appropriate.
Our prior authorization team submits the clinical criteria with the request and confirms the approved study type before scheduling. When the study leads to CPAP, the equipment is usually billed as a capped rental, so we track the rental months and the compliance documentation the payer requires to keep paying.
Nebulizer treatments and inhalation drugs
Drugs given through a nebulizer sit at the boundary between the medical and DME benefits. In the office, the inhalation treatment is billed with 94640 while the drug itself often goes to the DME contractor with its J-code, following the local coverage article's drug list and diagnosis requirements.
Mixing the two, or billing the drug to the wrong contractor, is a steady source of denials. We verify which benefit covers the drug for each payer before the first treatment, and keep the drug, dose and administration method documented so refills do not stall on medical necessity.
Common pulmonology denials and how we prevent them
| Denial | Typical cause | Prevention step |
|---|---|---|
| PFT not medically necessary | Test ordered without documented symptoms or diagnosis | Symptoms checked against the order before testing |
| Bundled testing codes | Components reported that the payer considers included | Component codes matched to the equipment report |
| Sleep study denied | Criteria for apnea not documented in the request | Clinical criteria submitted with the authorization |
| Nebulizer drug denied | Drug billed to the wrong contractor or benefit | Benefit and contractor verified before treatment |
| Post-bronchoscopy visit denied | E/M billed inside the global period | Global periods tracked by patient |
Denial patterns get fixed at the source. If one payer keeps denying home sleep tests, the intake questionnaire changes so the criteria are captured before the authorization request goes out.
How Fastora supports pulmonology practices
Fastora works inside your existing EHR/PM system under the user access you grant, with no software to install and no hidden setup fees. You get a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call.
Fees are quoted after a free assessment, so we can see your payer mix, testing volume and sleep program setup first. Start with a free billing assessment and we will show you where claims are slowing down before you commit to anything.
Pulmonology billing: sleep studies, PFTs, and chronic care
Pulmonology medical billing mixes diagnostics with longitudinal care. Sleep studies need prior authorization with documented medical necessity before the night of the study — not after. Pulmonary function tests are straightforward when the interpretation is documented and far less so when it is not. And chronic programs for COPD and asthma live or die on care-plan documentation that supports the ongoing codes. We keep the diagnostic and chronic workflows separate on the back end so each claim is built to its own rules, with denials worked against the service that produced them. Related: free medical billing audit, medical billing services, pricing.