Procedure-Specific Billing
Specialized Billing for Every Pulmonology Service
Each pulmonology service category carries its own bundling rules, add-on code requirements, DME authorization standards, and payer documentation expectations. ProtoMed's certified team handles every service correctly, capturing the full reimbursement value of every diagnostic, procedural, and management service your practice provides.
Pulmonary Function Testing Billing
PFT billing requires careful code selection to avoid bundling denials. Simple spirometry (CPT 94010) cannot be billed on the same day as comprehensive pulmonary function testing that already includes spirometric measurement. Pre- and post-bronchodilator spirometry has its own code (CPT 94060). Diffusing capacity, lung volume, and comprehensive PFT panels must be coded as standalone studies without duplicating component codes. We select the correct PFT codes for each session and prevent the bundling conflicts that automatically trigger claim denial.
Bronchoscopy Billing
Flexible bronchoscopy billing uses a primary procedure code with add-on codes for each additional intervention performed: bronchoalveolar lavage, endobronchial biopsy, transbronchial biopsy, and therapeutic procedures. Add-on codes must follow the correct sequencing rules and cannot be billed as standalone procedures. We accurately code every bronchoscopy encounter, apply the correct primary and add-on code sequence, and ensure the procedural documentation supports every billed intervention.
Sleep Study & Polysomnography Billing
Sleep study billing depends on whether the study was attended (in a sleep lab with technician supervision) or unattended (home-based device), and on the number of channels recorded. Attended polysomnography uses different codes than home sleep testing, and CPAP titration during the same night as a diagnostic study requires specific split-night coding. We accurately distinguish attended from unattended studies, select the correct channel-based code, and apply split-night coding rules when titration and diagnostic monitoring occur in the same session.
CPAP/BiPAP DME Billing & Authorization
CPAP and BiPAP DME authorization requires documented AHI criteria from the diagnostic sleep study, a treating physician order, and 30-day compliance data from device download before ongoing rental reimbursement is confirmed. Medicare imposes strict LCD requirements. Missed documentation at any step results in denied DME claims. We manage the complete CPAP and BiPAP billing lifecycle from initial authorization through compliance verification and ongoing monthly billing, ensuring no device rental revenue is lost to documentation gaps.
Chronic Respiratory Disease Management
COPD, IPF, asthma, and pulmonary hypertension patients generate high-complexity E/M encounters, and the documentation must support the MDM complexity level billed. Chronic respiratory disease management also frequently qualifies for CCM and TCM billing, representing significant recurring revenue that most pulmonology practices underclaim. We ensure every complex pulmonary E/M visit is coded at the appropriate MDM-based level and identify every eligible CCM and TCM service across your patient panel.
Thoracentesis & Pleural Procedure Billing
Thoracentesis and other pleural procedures, including pleural biopsy, chest tube placement, and pleurodesis, must be billed with the correct CPT code based on whether imaging guidance was used and whether the procedure was diagnostic or therapeutic. When ultrasound guidance is used, the imaging add-on code must be separately billed and documented. We accurately code every pleural procedure, apply imaging guidance add-on codes correctly, and ensure the procedural documentation supports the full reimbursement value of each intervention.
