Pulmonology billing spans PFT panels, bronchoscopy add-ons, sleep studies that almost always need prior auth, and critical care time that's routinely underbilled when ventilator management gets coded as standard subsequent care instead.
Common Billing Challenges
These are the six billing failure points we see most often in pulmonology practices — and the ones our team resolves systematically from day one.
Each test in a PFT panel must be documented as performed, interpreted, and clinically indicated on that date. Billing every code in the panel when only some tests were actually done is overbilling.
Bronchoscopy with biopsy (31625) already includes the diagnostic component — it replaces the base bronchoscopy code (31622), it isn't billed alongside it as an add-on.
Prior authorization is almost universally required for sleep studies. Submitting without it is a predictable denial, and indication documentation has to match payer criteria exactly.
Defaulting to standard subsequent hospital care codes instead of 99291/99292 when actively managing a ventilated patient leaves real time-based revenue on the table.
G0424 covers up to 36 sessions for qualifying COPD patients under a physician-prescribed program, but it's often underused even when patients clearly meet the criteria.
Stations sampled, node size, and technique used all need explicit documentation in the note — EBUS billing without that level of detail is a denial waiting to happen.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in pulmonology.
| CPT Code | Description | Common Issue |
|---|---|---|
| 94010 / 94060 | Spirometry, with/without bronchodilator | 94060 is an add-on; both need same-date clinical indication |
| 94726 / 94729 | Plethysmography / diffusion capacity (DLCO) | Each must be separately documented as performed and interpreted |
| 31622 / 31625 | Diagnostic bronchoscopy / with biopsy | 31625 replaces 31622, never billed alongside it |
| 95810 / 95811 / 95806 | Sleep studies — Type I, with CPAP titration, Type III home | Prior auth almost universally required |
| 99291 / 99292 | Critical care, first hour / each additional 30 min | Requires documented direct hands-on management time |
| 31652 / 31653 | EBUS with biopsy for lymph node staging | Requires stations sampled, node size, technique documented |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to pulmonology — not a generic CPC only.
We catch bronchoscopy base-code stacking errors and missing sleep study prior auth before submission — two of the fastest ways to a pulmonology denial.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your procedure schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.