LCD Reference Article Billing and Coding Article

Billing and Coding: Pulmonary Stress Testing

A56784

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56784
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Pulmonary Stress Testing
Article Type
Billing and Coding
Original Effective Date
08/01/2019
Revision Effective Date
01/31/2024
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Pulmonary Stress Testing L33444.

 

Response To Comments

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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(4 Codes)
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Group 1 Codes
Code Description
94617 EXERCISE TEST FOR BRONCHOSPASM, INCLUDING PRE- AND POST-SPIROMETRY AND PULSE OXIMETRY; WITH ELECTROCARDIOGRAPHIC RECORDING(S)
94618 PULMONARY STRESS TESTING (EG, 6-MINUTE WALK TEST), INCLUDING MEASUREMENT OF HEART RATE, OXIMETRY, AND OXYGEN TITRATION, WHEN PERFORMED
94619 EXERCISE TEST FOR BRONCHOSPASM, INCLUDING PRE- AND POST-SPIROMETRY AND PULSE OXIMETRY; WITHOUT ELECTROCARDIOGRAPHIC RECORDING(S)
94621 CARDIOPULMONARY EXERCISE TESTING, INCLUDING MEASUREMENTS OF MINUTE VENTILATION, CO2 PRODUCTION, O2 UPTAKE, AND ELECTROCARDIOGRAPHIC RECORDINGS
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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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(195 Codes)
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Group 1 Codes
Code Description
B44.81 Allergic bronchopulmonary aspergillosis
C33 Malignant neoplasm of trachea
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C34.91 Malignant neoplasm of unspecified part of right bronchus or lung
C34.92 Malignant neoplasm of unspecified part of left bronchus or lung
C78.01 Secondary malignant neoplasm of right lung
C78.02 Secondary malignant neoplasm of left lung
C78.39 Secondary malignant neoplasm of other respiratory organs
D14.2 Benign neoplasm of trachea
D14.31 Benign neoplasm of right bronchus and lung
D14.32 Benign neoplasm of left bronchus and lung
D86.0 Sarcoidosis of lung
D86.1 Sarcoidosis of lymph nodes
D86.2 Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.3 Sarcoidosis of skin
D86.81 Sarcoid meningitis
D86.82 Multiple cranial nerve palsies in sarcoidosis
D86.85 Sarcoid myocarditis
D86.86 Sarcoid arthropathy
D86.87 Sarcoid myositis
D86.89 Sarcoidosis of other sites
D86.9 Sarcoidosis, unspecified
E84.0 Cystic fibrosis with pulmonary manifestations
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.21 Secondary pulmonary arterial hypertension
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.29 Other secondary pulmonary hypertension
I27.9 Pulmonary heart disease, unspecified
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I50.22 Chronic systolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
J39.8 Other specified diseases of upper respiratory tract
J41.0 Simple chronic bronchitis
J41.1 Mucopurulent chronic bronchitis
J41.8 Mixed simple and mucopurulent chronic bronchitis
J42 Unspecified chronic bronchitis
J43.0 Unilateral pulmonary emphysema [MacLeod's syndrome]
J43.1 Panlobular emphysema
J43.2 Centrilobular emphysema
J43.8 Other emphysema
J43.9 Emphysema, unspecified
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.9 Chronic obstructive pulmonary disease, unspecified
J45.20 Mild intermittent asthma, uncomplicated
J45.30 Mild persistent asthma, uncomplicated
J45.40 Moderate persistent asthma, uncomplicated
J45.50 Severe persistent asthma, uncomplicated
J45.909 Unspecified asthma, uncomplicated
J45.990 Exercise induced bronchospasm
J45.991 Cough variant asthma
J45.998 Other asthma
J47.9 Bronchiectasis, uncomplicated
J60 Coalworker's pneumoconiosis
J61 Pneumoconiosis due to asbestos and other mineral fibers
J62.0 Pneumoconiosis due to talc dust
J62.8 Pneumoconiosis due to other dust containing silica
J63.0 Aluminosis (of lung)
J63.1 Bauxite fibrosis (of lung)
J63.2 Berylliosis
J63.3 Graphite fibrosis (of lung)
J63.4 Siderosis
J63.5 Stannosis
J63.6 Pneumoconiosis due to other specified inorganic dusts
J64 Unspecified pneumoconiosis
J65 Pneumoconiosis associated with tuberculosis
J66.0 Byssinosis
J66.1 Flax-dressers' disease
J66.2 Cannabinosis
J66.8 Airway disease due to other specific organic dusts
J67.0 Farmer's lung
J67.1 Bagassosis
J67.2 Bird fancier's lung
J67.3 Suberosis
J67.4 Maltworker's lung
J67.5 Mushroom-worker's lung
J67.6 Maple-bark-stripper's lung
J67.7 Air conditioner and humidifier lung
J67.8 Hypersensitivity pneumonitis due to other organic dusts
J67.9 Hypersensitivity pneumonitis due to unspecified organic dust
J70.1 Chronic and other pulmonary manifestations due to radiation
J70.3 Chronic drug-induced interstitial lung disorders
J70.8 Respiratory conditions due to other specified external agents
J70.9 Respiratory conditions due to unspecified external agent
J82.81 Chronic eosinophilic pneumonia
J82.83 Eosinophilic asthma
J84.10 Pulmonary fibrosis, unspecified
J84.111 Idiopathic interstitial pneumonia, not otherwise specified
J84.112 Idiopathic pulmonary fibrosis
J84.113 Idiopathic non-specific interstitial pneumonitis
J84.115 Respiratory bronchiolitis interstitial lung disease
J84.116 Cryptogenic organizing pneumonia
J84.117 Desquamative interstitial pneumonia
J84.170 Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere
J84.178 Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere
J84.2 Lymphoid interstitial pneumonia
J84.82 Adult pulmonary Langerhans cell histiocytosis
J84.83 Surfactant mutations of the lung
J84.842 Pulmonary interstitial glycogenosis
J84.843 Alveolar capillary dysplasia with vein misalignment
J84.848 Other interstitial lung diseases of childhood
J84.89 Other specified interstitial pulmonary diseases
J95.3 Chronic pulmonary insufficiency following surgery
J96.10 Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
J96.11 Chronic respiratory failure with hypoxia
J96.12 Chronic respiratory failure with hypercapnia
J96.90 Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
J96.91 Respiratory failure, unspecified with hypoxia
J96.92 Respiratory failure, unspecified with hypercapnia
J98.09 Other diseases of bronchus, not elsewhere classified
J98.3 Compensatory emphysema
J98.6 Disorders of diaphragm
J98.8 Other specified respiratory disorders
J99 Respiratory disorders in diseases classified elsewhere
M05.111 Rheumatoid lung disease with rheumatoid arthritis of right shoulder
M05.112 Rheumatoid lung disease with rheumatoid arthritis of left shoulder
M05.121 Rheumatoid lung disease with rheumatoid arthritis of right elbow
M05.122 Rheumatoid lung disease with rheumatoid arthritis of left elbow
M05.131 Rheumatoid lung disease with rheumatoid arthritis of right wrist
M05.132 Rheumatoid lung disease with rheumatoid arthritis of left wrist
M05.141 Rheumatoid lung disease with rheumatoid arthritis of right hand
M05.142 Rheumatoid lung disease with rheumatoid arthritis of left hand
M05.151 Rheumatoid lung disease with rheumatoid arthritis of right hip
M05.152 Rheumatoid lung disease with rheumatoid arthritis of left hip
M05.161 Rheumatoid lung disease with rheumatoid arthritis of right knee
M05.162 Rheumatoid lung disease with rheumatoid arthritis of left knee
M05.171 Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot
M05.172 Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot
M05.19 Rheumatoid lung disease with rheumatoid arthritis of multiple sites
M31.0 Hypersensitivity angiitis
M32.13 Lung involvement in systemic lupus erythematosus
M33.01 Juvenile dermatomyositis with respiratory involvement
M33.11 Other dermatomyositis with respiratory involvement
M33.21 Polymyositis with respiratory involvement
M33.91 Dermatopolymyositis, unspecified with respiratory involvement
M34.81 Systemic sclerosis with lung involvement
M35.02 Sjogren syndrome with lung involvement
M41.112 Juvenile idiopathic scoliosis, cervical region
M41.113 Juvenile idiopathic scoliosis, cervicothoracic region
M41.114 Juvenile idiopathic scoliosis, thoracic region
M41.115 Juvenile idiopathic scoliosis, thoracolumbar region
M41.116 Juvenile idiopathic scoliosis, lumbar region
M41.117 Juvenile idiopathic scoliosis, lumbosacral region
M41.122 Adolescent idiopathic scoliosis, cervical region
M41.123 Adolescent idiopathic scoliosis, cervicothoracic region
M41.124 Adolescent idiopathic scoliosis, thoracic region
M41.125 Adolescent idiopathic scoliosis, thoracolumbar region
M41.126 Adolescent idiopathic scoliosis, lumbar region
M41.127 Adolescent idiopathic scoliosis, lumbosacral region
M41.22 Other idiopathic scoliosis, cervical region
M41.23 Other idiopathic scoliosis, cervicothoracic region
M41.24 Other idiopathic scoliosis, thoracic region
M41.25 Other idiopathic scoliosis, thoracolumbar region
M41.26 Other idiopathic scoliosis, lumbar region
M41.27 Other idiopathic scoliosis, lumbosacral region
R05.2 Subacute cough
R05.3 Chronic cough
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.3 Periodic breathing
R06.82 Tachypnea, not elsewhere classified
R06.89 Other abnormalities of breathing
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
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Other Coding Information

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/31/2024 R8

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added E84.0.

12/07/2023 R7

Under CMS National Coverage Policy removed the following regulations: CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §231 Pulmonary Rehabilitation (PR) Program Services Furnished On or After January 1, 2010 and CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §240.7 Postural Drainage Procedures and Pulmonary Exercises.

10/01/2021 R6

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes the description was revised for M35.02 and added R05.2 and R05.3. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

06/17/2021 R5

Under CMS National Coverage Policy updated descriptions and headings to regulations.

01/01/2021 R4

Under CPT/HCPCS Codes Group 1: Codes added 94619 and changed descriptor for 94617. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/01/2020 R3

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted J82 and J84.17 and added J84.170, J84.178, J82.81, and J82.83. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/17/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Pulmonary Stress Testing L33444 LCD and placed in this article.

08/01/2019 R1

All coding located in the Coding Information section has been removed from the related Pulmonary Stress Testing L33444 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33444 - Pulmonary Stress Testing
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/20/2023 01/31/2024 - N/A Currently in Effect You are here
11/27/2023 12/07/2023 - 01/30/2024 Superseded View
08/16/2021 10/01/2021 - 12/06/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Pulmonary Stress Testing