What we bill · Pulmonary function testing
PFT billing: where pulmonology revenue leaks first
Pulmonary function tests are high-volume, code-dense, and denied more often than almost anything else a pulmonology practice bills. Three failure points cause most of it — and a competent biller prevents all three.
Compare free quotesWhy PFT claims get denied
The three failure points
1. The missing interpretation. Payers require both the technical performance and a signed physician interpretation report. If the interpretation isn't documented when the claim goes out, expect a denial. The workflow fix: interpretation verified before submission, as a hard stop — every claim.
2. Wrong code for the panel. 94010 basic spirometry, 94060 with bronchodilator response, 94726 lung volumes, 94729 DLCO, 94618 pulmonary stress testing, plus 94760/94761 oximetry. Panels get miscoded when billers guess from the charge slip instead of reading the test report.
3. Component confusion. Hospital or shared-facility testing splits into professional (modifier 26) and technical (TC) components. Practice-owned equipment bills global. A biller without standing site-of-service rules will bounce claims in both directions.
Three questions any competent biller answers instantly
At what point in your workflow do you confirm the PFT interpretation is documented? How do you decide between coding 94010 and 94060? When does our testing bill with modifier 26 versus globally? Hesitation on any of these predicts denials on all of them.
Want the full code-by-code reference? Read the complete PFT & spirometry coding guide.
PFT billing, answered
What CPT codes cover pulmonary function testing?
The core set: 94010 (spirometry), 94060 (spirometry with bronchodilator), 94726 (lung volumes), 94729 (DLCO), 94618 (pulmonary stress test), and 94760/94761 (pulse oximetry). Which apply depends on the panel the lab actually ran.
Why was our PFT claim denied for “missing documentation”?
Most often the signed physician interpretation wasn't in the record at billing. It's a required component of the claim, not supporting paperwork.
Test every quote on the details
Get competitive quotes, then ask each biller the three PFT questions above. The answers separate specialists from templates.
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