Pulmonology Medical Billing Services for Respiratory & Critical Care Practices in the USA
Respiratory and pulmonary care billing expertise for clinics and sleep centers.
Specialty highlight
97%
Built around payer rules, documentation requirements, and coding nuances.
Diagnostic Test Coding Accuracy
97%
Clean Claim Rate
95%
Pulmonology Billing Services for High-Complexity Respiratory & Critical Care Practices
Pulmonology billing involves a combination of office-based evaluation for chronic conditions like COPD and asthma, and a high volume of diagnostic testing such as pulmonary function tests (PFTs) and bronchoscopies. Our pulmonology billing service is designed to manage this mix, ensuring accurate coding for all consultations, procedures, and interpretations, while navigating the complex payer policies for respiratory care to maximize your practice's revenue.
Pulmonary Function Test (PFT) Coding
Component-by-component coding for spirometry (94010-94070), lung volumes (94727), diffusion capacity (94729), and bronchoprovocation testing with correct professional and technical component billing.
Bronchoscopy & Interventional Pulmonology Billing
Precise CPT coding for bronchoscopies (31622-31654) including diagnostic, BAL, endobronchial biopsies, and advanced navigation bronchoscopy with correct add-on code application.
Sleep Study & CPAP/DME Billing
Accurate coding for full in-lab polysomnography (95810), home sleep tests (95800-95801), and CPAP/BiPAP supplies, managing prior authorizations and LCD compliance for every study ordered.
Critical Care & Ventilator Management Billing
Specialized billing for pulmonary critical care (99291, 99292) and ventilator management with precise time-based documentation review, ensuring every hour of critical care is captured and justified.
Pulmonology Billing Challenges That Reduce Your Revenue
Pulmonology billing combines procedure-heavy PFT and bronchoscopy coding with the documentation complexity of critical care. These are the barriers our team systematically eliminates.
- Accurately coding for a variety of pulmonary function tests (PFTs), including spirometry, DLCO, and lung volumes.
- Billing for bronchoscopy procedures, including with biopsies, lavage, and navigation.
- Ensuring proper coding for sleep studies and the management of sleep-related breathing disorders.
- Managing the complexities of billing for prolonged critical care services in pulmonary critical care.
- Navigating payer policies for home oxygen therapy and DME for respiratory patients.
- Certified pulmonology coders with expertise in respiratory diseases, diagnostic tests, and interventional procedures.
- Precise coding for all PFTs, bronchoscopies, and other pulmonary diagnostic studies.
- Expertise in billing for sleep medicine, including polysomnography (PSG) and home sleep tests (HST).
- Accurate coding for critical care services and ventilator management in the ICU setting.
- Proactive verification of coverage and prior authorization for sleep studies and complex procedures.
- Detailed support for billing for home oxygen, CPAP, and other DME.
How We Keep Your Pulmonology Claims Accurate & Paid Fast
Our pulmonology billing workflows are built for the diagnostic and therapeutic breadth of respiratory medicine, ensuring every study, procedure, and critical care encounter is coded correctly.
Pulmonary Function Test Component Coding
Specialized coding for the full PFT spectrum (94010-94750) — spirometry, DLCO, lung volumes, body plethysmography, and bronchoprovocation — with correct pre/post bronchodilator distinction and professional component billing.
Bronchoscopy & Advanced Pulmonary Procedure Billing
Precise coding for diagnostic and therapeutic bronchoscopies (31622-31654), including BAL, transbronchial biopsies, stent placement, and navigational bronchoscopy with correct add-on code sequencing.
Sleep Study & CPAP Compliance Billing
Expert coding for all sleep study types (95782-95811, 95800-95801), CPAP/BiPAP supply billing, and prior authorization management with payer-specific LCD compliance review for every study.
Critical Care & Ventilator Management
Time-based critical care coding (99291, 99292) and daily hospital management billing for ventilator-dependent patients with precise documentation review to capture every billable unit of critical care time.
Home Oxygen & DME Billing
Complete billing for home oxygen equipment (E0424-E0605), concentrators, portable units, and liquid oxygen under both Medicare's CMN requirements and commercial payer coverage policies.
Pulmonology Coding Complexities & Denial Prevention for Claim Accuracy
From PFT component sequencing to bronchoscopy add-on codes, these are the precision coding areas that determine reimbursement accuracy for pulmonology practices.
- PFT coding based on the specific tests performed (spirometry, lung volumes, diffusion capacity).
- Bronchoscopy coding depending on the type of procedure (diagnostic, with biopsy, with navigation).
- Sleep study coding based on type (full PSG vs. home test) and parameters recorded.
- Correct coding for prolonged physician services in critical care (99291, 99292).
Missing medical necessity for PFTs or sleep studies.
Lack of prior authorization for sleep studies or bronchoscopies.
Incorrect coding for the type of PFT performed.
Bundling issues with bronchoscopy procedures and biopsies.
Insufficient documentation for critical care time.
Common Pulmonology CPT & ICD-10 Codes for Accurate Billing & Reimbursement
Our pulmonology coders are trained across the complete respiratory medicine CPT and ICD-10 code set, from outpatient COPD management to ICU-based ventilator management and interventional bronchoscopy.
CPT
94010 (Spirometry), 94760 (Oximetry), 31622 (Bronchoscopy), 95810 (Polysomnography), 99214 (Office Visit)
ICD-10
J44.9 (COPD), J45.909 (Asthma), J96.90 (Respiratory Failure), G47.33 (Obstructive Sleep Apnea), J15.9 (Bacterial Pneumonia)
Frequently Asked Questions
Got questions? We've got answers
Revenue cycle services for this specialty
Connect specialty-specific billing needs with the core MI MedCare services that keep claims accurate, compliant, and moving.
Medical Billing
End-to-end medical billing services that improve claim acceptance and accelerate reimbursements.
Revenue Cycle Management
Complete RCM solutions covering patient intake, billing, payments, and financial reporting.
Medical Coding
Certified coders ensure accurate ICD-10, CPT, and HCPCS coding for compliant claims.
Credentialing
Provider credentialing and payer enrollment to get your practice contracted faster.
Eligibility Verification
Insurance eligibility and benefits verification before services are delivered.
Denial Management
Identify denial causes, correct errors, and recover lost revenue efficiently.