Pulmonology billing
Pulmonology billing services
We handle billing for pulmonology, critical care and sleep medicine practices, from pulmonary function tests and bronchoscopy to sleep studies and hospital visits. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- PFT codes combined correctly so tests are not billed twice
- Bronchoscopy and EBUS coded with NCCI edits and modifiers checked
- Sleep study authorizations and home vs in-lab rules tracked
Why pulmonology billing is different
Pulmonology bills in the office, the lab and the ICU
A pulmonology group can bill office visits, lung function testing, procedures, sleep studies and critical care in the same week. Each setting has different rules.
Pulmonary function testing
Spirometry, pre- and post-bronchodilator testing, lung volumes and diffusion capacity have separate codes, and some include others. Billing spirometry with a bronchodilator study for the same session is a common edit.
Bronchoscopy families
Diagnostic bronchoscopy is included in every surgical bronchoscopy. Lavage, biopsies and EBUS each have their own codes, and NCCI edits decide when modifier 59 or XS is allowed.
Sleep studies
In-lab polysomnography, titration studies and home sleep tests are coded differently, and Medicare uses its own codes for some home tests. Many payers require a home test first or prior authorization for an in-lab study.
Critical care and hospital visits
Critical care is billed by time, with an add-on for each extra 30 minutes. Time must be documented, and split or shared visits with NPs or PAs follow payer rules.
Professional vs technical
When testing is done in a hospital lab, the pulmonologist bills only the interpretation with modifier 26. In an office lab the practice may bill the global service.
Biologics and DME support
Asthma biologics given in the office need authorization, drug units and wastage reporting. Oxygen and CPAP suppliers also need your documentation, and gaps can delay their claims and your patients’ equipment.
Common codes
Pulmonology codes we review before every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 94010 / 94060 | Spirometry; spirometry before and after bronchodilator | Not billed together for the same session |
| 94726 / 94727 / 94729 | Lung volumes (plethysmography or gas dilution); diffusion capacity add-on | Add-on reported with a primary PFT code |
| 94618 | Pulmonary stress testing, such as a 6-minute walk | Oxygen monitoring and documentation of the test |
| 31622–31628 | Bronchoscopy: diagnostic, lavage, biopsy, transbronchial lung biopsy | Diagnostic scope included in surgical codes; lobe and site counts |
| 31652 / 31653 / 31654 | EBUS-guided sampling (1–2 or 3+ stations); peripheral EBUS add-on | Station count documented; NCCI pairs and modifiers |
| 95810 / 95811 / 95806 | Attended polysomnography; with CPAP titration; unattended home sleep test | Authorization, home test requirements, 26/TC split |
| 99291 / 99292 | Critical care, first 30–74 minutes and each additional 30 minutes | Total time documented; excluded services not added |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
The pulmonology denials we stop before they happen
Pulmonology denials tend to come from bundling, time and authorization. We check each one before the claim goes out.
- Spirometry and bronchodilator testing billed together for one session
- Diagnostic bronchoscopy billed with a surgical bronchoscopy code
- Modifier 59 or XS missing, or used where NCCI does not allow it
- In-lab sleep studies denied because a home test or prior authorization was required first
- Critical care denied or down-coded because total time was not documented
- Global PFT or sleep claims billed when the hospital billed the technical component
- Biologic injection claims missing authorization, units or the wastage modifier
What we handle
Everything between the visit and the payment
Our core focus is behavioral health. We bill pulmonology practices with the same team, the same process and the same promises.
- Insurance eligibility, benefits and prior authorization checks before visits, studies and procedures
- Charge entry and coding review of E/M, PFT, bronchoscopy, sleep and critical care codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing, including hospital-based providers
- Patient statements and balance tracking (patient calls go to your office or an optional RevenueCTRL virtual assistant)
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for pulmonology practices
Billing starts at 2.5% of collections, or a flat monthly fee. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing. No setup fee and no long-term contract.
Common questions
Can we bill spirometry and a full PFT on the same day?
Often yes, but not every combination. Lung volumes and diffusion capacity can usually be billed with spirometry, while spirometry and pre- and post-bronchodilator spirometry are not billed together for one session. We apply current NCCI edits and each payer’s rules.
Do you bill EBUS bronchoscopy?
Yes. We code EBUS-guided sampling by the number of lymph node stations sampled and add the peripheral EBUS add-on when it is documented. The diagnostic bronchoscopy is included and not billed separately.
Do you handle home sleep tests and in-lab studies?
Yes. We bill both and check whether the payer requires a home test before an in-lab study, and whether authorization is needed. When a hospital or sleep lab owns the equipment, we bill only the interpretation.
Can you bill critical care for our hospital work?
Yes. We bill critical care by documented total time, with the add-on code for each extra 30 minutes. We also check split or shared visit rules when an NP or PA is involved.
How fast do you reply to questions?
A real person replies to calls and emails within 1 hour during business hours, Monday to Friday, 9am to 6pm Eastern.
Can you credential our providers at new hospitals?
We handle payer credentialing for every provider. It starts at $80 per payer, and 5 commercial payers are credentialed free with billing. Medicare and Medicaid enrollments are priced separately.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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