Pulmonary billing
Sleep studies, PFTs, and complex critical-care/inpatient mixes — billing flows that demand specialist coders.
Pulmonary practices that use generalist coders consistently leave 10%+ on the table through PFT under-coding and missed bronch add-ons.
Where revenue leaks
The pulmonary traps we see most
Patterns we run into across Pulm practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
Sleep study auth + interpretation timing
Polysomnograms (95810, 95811) require prior auth from most commercial payers, plus a follow-up visit for results. Practices that don't track auth windows or interpretation dates lose claims to timely-filing denials.
PFT under-coding
Spirometry (94010), full PFT (94060), DLCO (94729), methacholine (94070) — each has specific component coding. Many practices bill 94010 default when the testing performed justified the higher-paying combinations.
Bronchoscopy bundling
Diagnostic bronch (31622) plus add-ons (BAL 31624, biopsy 31625, brushing 31623) with EBUS (31652–31654) has specific bundling rules. Wrong combinations get denied or pay lower than warranted.
Inpatient critical care under-captured
Pulmonologists frequently provide critical care during ICU consults but bill subsequent inpatient (99232) instead of 99291. Time-based critical care documentation is required and often missed.
Coding focus
Where our coders specialize
- PFT (94010, 94060, 94070, 94729, 94375)
- Sleep studies (95800, 95806, 95810, 95811, G0398–G0400)
- Bronchoscopy (31622–31652)
- Critical care (99291, 99292)
- Inpatient consults (99231–99233 follow-up under post-2010 rules)
- DME orders (oxygen, BiPAP, CPAP) — separate billing flow
Texas payer notes
Local rules we navigate every day
- Texas Medicare (Novitas) LCDs for sleep studies are strict on documentation of medical necessity
- DME billing for CPAP/BiPAP requires compliance reporting (95% adherence by day 90 for Medicare)
- Commercial payers (BCBS TX, Aetna, UHC) increasingly require home sleep study before in-lab studies
Pulm KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for pulmonary.
100%
Sleep study auth on-time rate
98%+
PFT coding accuracy
tracked weekly
Critical care capture (when applicable)
What's your pulmonary practice leaking?
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Other specialties we serve