Pulmonology practices handle a wide mix of services — diagnostic testing, complex procedures, and chronic disease management. Each has specific coding requirements, and the margin for error is thin when payers are scrutinizing respiratory care more closely than they were even two years ago.
If you're working through these issues, our specialty billing services can help you address them systematically.
PFTs are the diagnostic backbone of pulmonology. The key codes:
A full PFT panel can legitimately include several of these codes. But billing all of them when only some were performed is overbilling. Each test must be documented as having been performed, interpreted, and clinically indicated on that date.
Bronchoscopy has a range of codes depending on what's done during the procedure. The base bronchoscopy code (31622) is rarely billed alone — it typically includes additional procedures:
The correct approach: bill the appropriate diagnostic bronchoscopy code(s) for what you actually did. Don't add procedure codes to inflate the claim. And don't bill the base code when you performed additional procedures that have their own codes.
Pulmonologists who supervise or interpret sleep studies bill through a set of Type I–IV codes. Type I (attended, in-lab full polysomnography) uses 95810 for the diagnostic study and 95811 if CPAP titration is performed during the same night. Type III (home sleep apnea testing) uses 95806.
Prior authorization is almost universally required for sleep studies. Submitting without auth is a predictable denial. And the indication documentation has to match payer criteria — typically an ESS score, documented symptoms, and a clinical note that reflects the pre-test evaluation.
ICU-level ventilator management uses daily critical care codes (99291, 99292) when the pulmonologist is providing critical care. The distinction: critical care billing requires that the physician is providing direct, hands-on management of a life-threatening condition — not just reviewing vent settings from a standing order.
A lot of pulmonologists underbill inpatient time by defaulting to standard subsequent hospital care codes when they're actually providing critical care. If the patient is on mechanical ventilation and you're managing their care actively, document and bill critical care.
Pulmonary rehabilitation (G0424) is a separately billable service for patients with COPD meeting specific criteria. It's often underused in pulmonology practices even when patients clearly qualify. Medicare covers up to 36 sessions with a physician-prescribed program and documentation of medical necessity.
Chronic care management codes (CCM) apply to COPD patients with two or more chronic conditions. PCM codes apply specifically to COPD as the principal condition being managed. These are real revenue that most pulmonology practices are leaving uncaptured.
EBUS procedures for lymph node staging have their own codes (31652, 31653). These are add-ons to the bronchoscopy code (31629 for EBUS guidance without biopsy, 31652/31653 for with biopsy). The documentation needs to reflect the EBUS component specifically — stations sampled, size of nodes, technique used. EBUS billing without this level of detail is a denial waiting to happen.
The billing gaps most practices don't catch until they show up as denials. Get the checklist — free, no spam.
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