Pulmonology
Pulmonology billing requires precise handling because the specialty involves pulmonary function testing, imaging interpretation, sleep study services, chronic respiratory disease management, and complex E/M encounters. We ensure accurate ICD 10 CM diagnosis coding, CPT and HCPCS procedure coding, modifier accuracy, and compliant E/M service selection across inpatient, outpatient, and emergency department professional fee encounters. Our team reviews documentation for PFTs, spirometry, bronchoscopy, sleep studies, asthma/COPD management, and long term respiratory care to confirm medical necessity, test interpretation, and payer required elements are fully supported.
Pulmonology denials frequently occur due to incomplete PFT documentation, missing interpretation statements, incorrect sleep study coding, insufficient justification for repeat testing, and unclear linkage between respiratory symptoms and procedures. We address these issues by strengthening documentation workflows, validating diagnosis to procedure alignment, and issuing provider queries when clarification is required. Our audits focus on identifying missed billable components such as bronchodilator responsiveness, add on testing codes, and separately reportable E/M services performed on the same day as diagnostics. We reinforce HIPAA compliance, documentation integrity, and payer policy adherence while optimizing pro fee charge capture across IP/OP/ED settings. Through targeted education and specialty specific denial analysis, we help pulmonology practices maintain a compliant, efficient revenue cycle that accurately reflects the full scope of respiratory care.