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Pulmonology Billing Services
Pulmonology billing is pulmonary function tests and the interpretation — plus sleep studies when the practice performs them — then bronchoscopy, six-minute walks, and inhalation treatments without bundling leaks. Vector Medical Billing, in Jamaica, New York, matches PFT components to the report and runs the cycle inside the EHR you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What pulmonology billing services include
Full-cycle RCM for pulmonary clinics, hospital-based pulmonologists, and groups that run PFT labs or sleep testing — clinic visits and respiratory diagnostics on one account.
The operating cycle matches medical billing services: eligibility and sleep/PFT auth when required, charge capture from notes and test reports, ICD-10 / CPT / HCPCS coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches PFT component bundling, interpretation documentation, 26/TC ownership, six-minute walk elements, bronchoscopy most-extensive-service rules, and sleep study type vs auth.
In scope: office/outpatient and inpatient pulmonary E/M, spirometry and full PFT panels with interpretation, pulmonary stress testing including 94618, bronchoscopy and EBUS, inhalation treatments, CPAP initiation/management when billed as a professional service, sleep studies when the practice performs them, and critical care when documented. Dedicated sleep-lab-only businesses can sit on sleep medicine billing. CPAP equipment capped rental usually rides the DME benefit — see DME when that is a separate supplier account.
The fee is a percentage of net collections. The written rate is on pricing. Credentialing, a retrospective coding audit, MIPS, and out-of-network / IDR stay separate engagements.
What sits on this pulmonology fee
- PFT components and interpretation matched to the report — not visit-only coding
- Sleep studies scrubbed for auth and 26/TC when the practice performs them
- HIPAA workflows, a signed BAA, and PHI limited to staff on the account
Where pulmonology claims fail
Patterns AARC respiratory coding guidance and specialty pulmonary RCM vendors keep naming on PFT and sleep days.
PFT components stacked wrong
94010 billed with 94060 for the same session. DLCO (94729) without a primary PFT code. Flow-volume loop unbundled from spirometry. Or technical test charged with no physician interpretation on file for Part B.
Bill what was performed — and only what was performed — against the equipment report.
Sleep study without criteria or auth
In-lab PSG or home sleep test scheduled before authorization, or auth for the wrong study type. Clinical criteria (witnessed apneas, ESS, resistant hypertension) missing from the request packet.
Confirm study type and 26/TC ownership before the night study runs.
Nebulizer / drug benefit mix-up
94640 billed with separate pre/post spirometry that AARC/NCCI treat as included for acute obstruction treatment. Nebulizer drug sent to the wrong contractor (Part B medical vs DME). Teaching code stacked incorrectly with treatment.
Verify drug benefit before the first treatment — not after the denial.
PFT · interpretation
Pulmonary function tests and the interpretation
Hub language made operational: components plus a physician read — not a silent machine printout.
Basic spirometry (94010) covers baseline spirometry without bronchodilator. Pre- and post-bronchodilator spirometry (94060) includes the baseline — never pair 94010 with 94060 for the same session. Lung volumes (e.g. 94726 plethysmography) and diffusing capacity (94729 as add-on) bill when performed and documented, with 94729 attached to a primary PFT code.
Medicare Part B expects a physician interpretation and report. When the practice owns the equipment and interprets, global billing may apply; when ownership splits, use 26 and TC correctly. Same-day office E/M needs modifier 25 only when the visit is significant and separately identifiable from ordering/interpreting the PFT.
PFT checklist
- Components match the completed test report
- No 94010 + 94060 same session
- Interpretation on file; 26/TC when ownership splits
Six-minute walk and bronchoscopy
Stress testing elements and most-extensive airway work.
94618 simple pulmonary stress
Six-minute walk and similar simple stress tests include heart rate, oximetry, and oxygen titration when performed, plus physician analysis. Document distance, dyspnea, desaturation, and O2 liter flow at rest, exercise, and recovery. Full cardiopulmonary exercise testing (94621) and bronchospasm exercise testing (94617) are different families — do not force 94618 onto them.
Interpretation is inclusive of 94618 — do not invent a second interpret code for the same walk.
Bronchoscopy / EBUS
Diagnostic bronchoscopy (31622) with washing when performed is a base code that bundles into more extensive bronchoscopic work. Biopsy, lavage, transbronchial sampling, and EBUS-guided station sampling (31652/31653 and related) require documented technique and station counts. Report the most extensive service performed; add distinct-site modifiers only when NCCI and the note support them.
Global period rules affect same-day or post-procedure E/M — track them before stacking a visit.
Sleep studies when the practice performs them
Auth, study type, and component split — then the claim.
Attended PSG
95810 / 95811 (and pediatric equivalents) for attended polysomnography with or without PAP titration. Reduce services with 52 when recording time thresholds are not met per payer/CMS rules. Parameters included in PSG are not unbundled as separate neuro codes.
Home sleep testing
Unattended codes (e.g. 95806 family) need medical necessity for home testing vs in-lab. Auth often specifies the approved study type — do not perform a different test than authorized.
26 / TC and CPAP follow-up
Split professional interpretation from technical acquisition when ownership differs. CPAP initiation/management (94660) is a professional service code — equipment rental months and compliance docs usually live on the DME claim, not inside the clinic PFT percentage.
Inhalation treatment and teaching
Acute obstruction treatment is not a full PFT session in disguise.
94640 and continuous inhalation
Inhalation treatment for acute airway obstruction (94640) — once per episode of care in many outpatient NCCI contexts. Continuous or back-to-back treatments exceeding one hour may use 94644/94645 instead; do not bill both families the same day. Modifier 76 may apply when a second distinct episode of care occurs the same date.
Do not add 94060 for spirometry inherent to that acute treatment episode.
Drug benefit and teaching
Nebulizer medication often bills under DME rules and contractor — not automatically with the office treatment line. Inhaler/nebulizer demonstration (94664) has its own frequency limits and should not be casually stacked with 94640. Verify benefit routing before the first fill.
Critical care (99291/99292) for pulmonary ICU work needs timed documentation and excluded-service awareness — see also hospitalist billing when that is a separate account.
Pulmonology code families this service works
Illustrative anchors — the report, auth, and payer policy decide the final claim.
| Work type | Example | What to check | Common failure if skipped |
|---|---|---|---|
| Office E/M | 99202–99215 ± 25 | Separate from PFT/sleep work | Visit omitted or habit-25 |
| Spirometry | 94010 / 94060 | Not both same session | Bundled stack |
| Volumes / DLCO | 94726 / 94729 | Add-on needs primary PFT | Orphan 94729 |
| Interpretation | Global or 26/TC | Written physician report | Tech-only claim |
| 6MWT | 94618 | HR, SpO2, O2 titration docs | Incomplete elements |
| Bronchoscopy | 31622–31654 | Most extensive; station count | Diagnostic + therapy unbundle |
| Sleep | 95810 / 95811 / 95806 | Auth; study type; 26/TC | Wrong study vs auth |
| Inhalation | 94640 / 94644 | Episode rules; drug benefit | Wrong contractor / NCCI |
This page does not invent a pulmonology denial percentage. The free audit reads your PFT components, interpretation gaps, and sleep auth on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
| Field | Example entry |
|---|---|
| Documented service | COPD follow-up with med change; complete PFT with pre/post spirometry, plethysmography, and DLCO; physician interpretation signed; practice owns equipment |
| Billed codes | 94010 + 94060 + 94729; no volumes; no E/M |
| Issue found | 94010 duplicated inside 94060; 94729 missing primary pairing clarity; 94726 not billed though performed; supported office E/M omitted |
| Recommended correction | 94060 + 94726 + 94729; drop standalone 94010; bill 99214-25 if visit stands alone from PFT work |
| Related check | Interpretation report present for Part B |
| Why it matters | Bundling denial risk plus missed volume and visit lines — caught in scrub or flagged in the free audit |
Request a Free Audit with recent notes, claims, and denials. We map PFT components and interpretation on your file — not this composite.
How Vector runs pulmonology billing
Components and interpretation first — then the same revenue cycle.
1
Assign pulmonology
Coder and biller who already work PFT panels, sleep auth, and bronchoscopy families.
2
Reconcile and code
Charge entry and coding from notes and PFT/sleep reports — queries when components are unclear.
Not inside the pulmonology percentage
Related work stays separate so the quote matches the job.
DME CPAP rental
Equipment capped rental and supply refills usually sit on a DME supplier claim — not inside the clinic PFT claim. See the hub DME card when that is separate.
Credentialing / audit
Credentialing and a retrospective coding audit of PFT panels are separate engagements when scoped.
Underpay / OON
Underpayment recovery and OON / IDR stay separate when the dispute path is not ordinary denial work.
How pulmonology billing is priced
Percentage of dollars that land — not a flat fee per spirometry that ignores component and sleep leaks.
Written rate
The fee is a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows visit and testing volume, sleep mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
EHR access, monthly visit and PFT census, whether you perform sleep studies, equipment ownership, open A/R if you are leaving another biller, and a sample of recent PFT or sleep denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the pulmonary claims that mis-stack PFT components
Send monthly visit and PFT volume, whether you run sleep studies, EHR name, and a sample of PFT or sleep denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate — without inventing a clean-claim percentage.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Pulmonology billing questions
Straight answers tied to the sections above.
What does pulmonology billing include?
Clinic E/M, PFTs with interpretation, sleep studies when performed, bronchoscopy, six-minute walk, inhalation treatments, scrubbing, submission, posting, denials, and A/R.
How much do pulmonology billing services cost?
The fee is a percentage of net collections. No setup fee on the monthly cycle. The written rate follows visit and testing volume and payer mix.
How are PFTs billed with interpretation?
Bill performed components only. 94060 includes baseline spirometry. Add-ons need a primary PFT. Physician interpretation is required for Part B; use 26/TC when ownership splits.
Does Vector bill sleep studies for pulmonology?
Yes when the practice performs them. Auth and 26/TC are scrubbed. Dedicated sleep-lab accounts can use sleep medicine billing when separate.
Can 94010 and 94060 be billed together?
Not for the same session when 94060 is performed — it already includes the baseline.
Do we have to change our EHR?
No. Billers work in the system you already use — see EHR integration. Compatibility is confirmed before you commit.
Where does Vector provide pulmonology billing?
The office is 15717 85th St, Jamaica, NY 11414-2620. Work is remote for pulmonary practices in all 50 states. See the specialties hub.
Is Vector Medical Billing HIPAA certified?
HHS does not certify billing companies. Vector signs a BAA, limits PHI to staff on the account, and follows HIPAA workflows. A HIPAA security risk analysis is a separate engagement when scoped.