ARCHIVED
Medical Policy
Policy Num: 02.005.001
Policy Name: Pulmonary Function Test
Policy ID: [02.005.001][Ac L M P ][0.00.00]
Last Review: November 04, 2022
Next Review: ARCHIVED
Issue: 11:2022
Related Policies: None
Pulmonary Function Test
| Population Reference No. | Populations | Interventions | Comparators | Outcomes |
| 1 | Individuals: - With pulmonary obstructive disease
| Interventions of interest are: | Comparators of interest are: - No pulmonary function testing
| Relevant outcomes include: · Overall survival · Disease specific survival · Test accuracy · Test validity · Medically Necessary |
Pulmonary function tests are those that measure the ability of the lungs to use air. These are done with the patient breathing normally, in inspiration and forced expiration and trying to keep as much air as possible in the lung. The results help diagnose breathing problems.
Pulmonary function tests are those that measure the ability of the lungs to use air. These are done with the patient breathing normally, in inspiration and forced expiration and trying to keep as much air as possible in the lung. The results help diagnose breathing problems.
1. Vital capacity - the largest amount of air that can be exhaled after a maximum inspiratory effort. Clinically, this measure is used as an indicator of pulmonary function.
2. Tidal volume - the amount of air that enters and leaves the lung with each respiratory cycle.
3. Total lung capacity - is the amount of gas that the lungs contain when they are fully expanded.
4. Residual volume - the amount of gas that remains in the lung at the end of a maximum expiration.
5. Residual functional capacity (Functional residual residual) - is the volume of gas left in the lungs at the end of normal breathing.
6. Maximum volume of ventilation Maximal volume ventilation (MVV) or capacity.
7. Maximal breathing capacity (MBC) - is the largest volume of gas that can move and leave the lungs in one minute by voluntary effort.
The most commonly used test for pulmonary evaluation is spirometry. This may include the measurement of vital capacity (1), one or more parameters of air flow during forced expiration and maximum ventilation. Most spyrometries can be used to measure air flow, but they do not measure lung capacity (3), residual functional capacity (5) or residual volume (4).
Most pulmonary problems can be grouped in those conditions that affect the expansion of the lung (restrictive) and those where there is increased resistance to the passage of air (obstructive). Both conditions can affect the exchange of gases, the main physiological function of the respiratory system. In addition to classifying pulmonary diseases as restrictive, obstructive, or mixed, pulmonary function studies are useful in determining the severity of the lung condition in a certain disease, monitoring its progress, and evaluating the effect of its treatment.
The objective of this review is to recommend which of the pulmonary function tests is the most appropriate in a specific clinical entity.
The following specific tests for evaluating pulmonary diseases are considered for payment:
PULMONARY OBSTRUCTIVE DISEASE ESTABLISHED (EOP). This category of diseases refers to conditions that reduce the lumen of the respiratory tract and produce a quantifiable reduction of the air flow.
| Diagnostic | ICD-10-CM (effective 10/1/15) |
| Chronic bronchitis | J41.1, J44.9, J44.1, J44.0, J41.8, J42 |
| Asthma | J45.20, J45.22, J45.21, J45.20, J45.22, J45.21, J44.0, J44.1, J45.991, J45.909 |
| Emphysema | J43.9, J43.9 |
| Tracheobronchitis | J95.02 |
| Stenosis of Larynx | J38.6 |
| Laryngeal Spasm | J38.5 |
| Other laryngeal conditions | J38.7 |
| Bronchiectasis | J47.9 |
| Chronic airway obstruction | J44.9 |
| Fumes and vapors (chronic respiratory condition) | J68.4 |
| Bronchiolitis | J21.8 |
POTENTIAL PULMONARY OBSTRUCTIVE DISEASE
PULMONARY FUNCTION TESTS
CPT 94010 - spirometry
CPT 94060 - spirometry before and after administering the bronchodilator or exercises
CPT 94375 - "respiratory flow volume loop" its use must be associated with the following criteria:
• locate and differentiate between intra and / or extra pulmonary defects
• distinguish between "malingering" and real lung defects,
• distinguish if the lung defect is in the upper or lower tracts
Note: CPT 94375 represents the graphic documentation of the information obtained during 94010 or 94060, in addition to providing graphic representation offers other advantages over 94010 or 94060, such as the following:
a) Differentiates between intra and extra thoracic obstruction.
b) The "flow volume loop" is the most versatile and most complete of the spirometry studies.
c) Although spirometry is the main study to establish pulmonary obstructive disease (PAD), the measurement of absolute lung volumes and the capacity of diffusion may be necessary for:
• differentiate type of lung disease
• document severity of the condition
• document non-communicating spaces
• document mild pulmonary disease
Billing guides:
a. Medical necessity for the services provided and frequency justification must be clearly documented in the medical record.
b. Only one of the three spirometry codes 94010, 94060 or 94375 may be billed with the appropriate ICD-9 for the initial evaluation of pulmonary obstructive disease.
c. The codes 94726, or 94727 will be covered in addition to spirometry. Only one of the two codes must be invoiced: 94726 or 94727.
• CPT 94726-94727 - Plethysmography for determination of lung volumes and, when performed, airway resistance: Gas dilution washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.
• CPT 94726-94727 - Plethysmography for determination of lung volumes and, when performed, airway resistance: gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.
• CPT 94729 - Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)
PULMONARY RESTRICTIVE DISEASE (ERP). These conditions result in a reduction in lung volume and are divided into the following categories:
A. Conditions due to loss of lung parenchyma:
| Diagnostic | ICD-10-CM (effective 10/1/15) |
| Emphysema resulting from a procedure | T81.82XA |
| Pulmonary Collapse – Allergy | J98.11, J98.19, J98.2, J98.3, J82, J81.0, J95.3, B44.81 |
| Neoplasm of Respiratory System | D49.1 |
| Pulmonary Eosinophilia | J82 |
| Pulmonary alveolar proteinosis – Idiopathic fibrosing alveolitis | J84.01, J84.03, J84.02, J84.1 |
| Other diseases of lung | J96.00, J96.90, J80, J96.10, J96.20, J98.4 |
| Pulmonary Manifestation Radiation | J70.1 |
| Rheumatoid lung | M05.10 |
| Lymphangioma, any site | D18.1 |
| Involvement Systemic Sclerosis | M34.81 |
| Extrinsic allergic alveolitis | J67.0, J67.1, J67.2, J67.3, J67.4, J67.5, J67.6, J67.7, J67.8, J67.9 |
| Pneumoconiosis | J60, J61, J62.8, J63.0, J63.1, J63.2, J63.3, J63.4, J63.5, J63.6 |
| Unspecified alveolar and parieto-alveolar pneumopathy | J84.9 |
| Pulmonary alveolar proteinosis | J84.01 |
| Idiopathic pulmonary hemosiderosis | J84.03 |
| Pulmonary alveolar microlithiasis | J84.02 |
| Pulmonary collapse | J98.11, J98.19 |
B. Extrapulmonary lesions of:
| Diagnostic | ICD-10-CM (Effective 10/1/15) |
| Thoracic wall | |
| Kyphosis | M40.00, M40.209 |
| Scoliosis | M41.20 |
| Congenital musculoskeletal deformities of spine | Q67.5, Q76.3, Q76.425, Q76.426, Q76.427, Q76.428 |
| Acquired spondylolisthesis | M43.00, M43.10 |
| Pectus excavatum | Q67.6 |
| Pleural | |
| Current Tuberculosis | J86.9, J94.1, J94.8, J94.9, R09.1 |
| Neuromuscular | |
| Myotonic disorders | No convierte |
| Hemiplegia | No convierte |
| Paraplegia | G82.20 |
| Paralytic syndromes | G83.81, G83.84, G83.89 |
| Polyneuropathy | G60.9 |
| Peripheral neuropathy | G71.0 |
| Myasthenia | G70.00 |
| Polymyositis | M33.20 |
| Acute lateral sclerosis | |
C. Pulmonary vascular diseases:
| Diagnostic | ICD-10-CM (Effective 10/1/15) |
| Vasculitis | J30.1 |
| Other diseases of lung not elsewhere | J98.4 |
D. Combined obstructive and destructive conditions:
| Diagnostic | ICD-10-CM (effective 10/1/15) |
| Sarcoidosis | D86.9 |
| Respiratory conditions | J70.1 |
| Heart failure | I50.9 |
| Other diseases of lung | J98.4 |
PULMONARY FUNCTION TESTS FOR PULMONARY RESTRICTIVE DISEASE (ERP)
CPT 94010 - Spirometry
CPT 94726 - Plethysmography for determination of lung volumes and, when performed airway resistance
CPT 94727 - Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.
CPT 94729 - See + 94729-Diffusing capacity Eg. Monoxide carbon, membrane)
Report + 94729 with 94010, 94060, 94070, 94375, 94726 - 94728
Billing guides:
Medical necessity and justification for the frequency must be documented in the medical record.
For evaluation and monitoring of ERP, the invoice codes are 94010, 94060, +94729.
Documentation Guides:
Medical records must document the medical necessity and the frequency of the tests.
BRONCHIAL HYPERSENSITIVITY:
This category of conditions refers to those in which the patient experiences symptoms sporadically or has symptoms without physical.
| Diagnostic | ICD-10-CM (effective 10/1/15) |
| Cough | R05 |
| Asthma equivalent/history of asthma with normal spirometry | R93.9 |
| Other symptoms involving respiratory system and chest | R06.00, R06.09, R06.3, R06.83, R06.89 |
Pulmonary function tests to evaluate bronchial hypersensitivity
CPT 94070 assessment of bronchospasm with multiple spyrometries after a dose of bronchodilator (aerosol only) antigen, exercise, cold, air or methacholine or other clinical agents, with spirometry as in CPT 94010.
Billing guides:
CPT 94070 is covered when invoiced with any previous ICD-10 code. Medical necessity must be documented.
Documentation Guides:
Medical records must document the medical necessity and the frequency of the tests
Pulmonary function tests for preoperative evaluation:
One or more of the following tests can be used to determine the operative and postoperative risk in patients with pre-existing lung disease.
| CPT | Description |
| 94060 | Bronchospasm evaluation; 94010 before and after bronchodilation or exercise |
| 94200 | "Maximum Breathing Capacity, maximal voluntary ventilation". |
| 94726 | Plethysmography for determination of lung volumes and, when performed, airway resistance |
| 94727 | Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes. |
| 94729 | Ver +94729-Diffusing capacity Eg. Carbon monoxide, membrane |
CPT 94200, 94729, 94726, 94727, are covered for:
1. Patient with a history or suspicion of lung disease who will undergo a thoracotomy or upper abdominal surgery.
2. Patients with advanced lung disease in whom the decision to carry out the surgery or refuse. This depends on the results of pulmonary function tests.
CPT 94060 is covered in:
1. The circumstances previously described (1 & 2)
2. Patients with known lung disease and that can be considered as high risk for postoperative pulmonary complications and in which high abdominal surgery is going to be carried out.
CPT 94680 is used only to evaluate patients before heart transplants.
Pulmonary Function Test where the TC component (production) is not considered for payment to the doctor. The modifier 26 (professional component) is recognized according to the guidelines below:
1. +94729- diffusion capacity (Eg Carbon monoxide, membrane)
2. 94750-Pulmonary compliance study, any method
Coding and Billing Guides:
The results of these tests are generated by a computer or by a technician, generally no additional interpretation is provided. If the physician provides a written interpretation for this test, the CPT code used must be accompanied by modifier 26 and with the appropriate diagnosis (ICD-9). These tests will only be paid when the invoice is accompanied by a report documenting the need to provide a written interpretation in addition to the results generated by the computer.
COVER FOR OTHER EXAMINATIONS OF PULMONARY FUNCTION:
| CPT | Description |
| 94150 | "Vital capacity, total (separate procedure)” |
Billing guides:
CPT 94150 It will be covered for diagnosis of obstructive pulmonary disease and is billed only (it will not be covered if invoiced with 94010, 94060, 94200 or 94375).
| CPT | Description |
| 94450 | Breathing response to hypoxia" (hypoxia response curve). |
| 94618 | Pulmonary Stress Testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed |
Cover for blood gases and ear oximetry
| CPT | Description |
| 82803 | Gases, blood, any combination of ph, pCO2, CO2, HCO2 (including calculated O2 saturation) |
| 82805 | with O2 saturation by direct measurement, except pulse oximetry |
| 82810 | Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry |
| 94760 | Noninvasive ear to pulse oximetry for oxygen saturation; single determination |
Billing and Coding Guides:
When the diagnosis is respiratory failure with any diagnosis of obstructive and / or restrictive lung disease. Only one of the four tests described above will be accepted for payment
Usage Guidelines:
Medical records must document the medical necessity and frequency of the tests. They will be covered only at ambulatory level.
Explanatory note for pulmonary function tests.
| CPT | Description |
| 94010 | Spirometry |
| 94060 | Spirometry before and after the administration of a bronchodilator. Here the response to the bronchodilator or exercises is evaluated. It is a diagnostic test and does not constitute a treatment |
| 94375 | Respiratory flow volume loop-is a graphical documentation of the information obtained during the performance of 94010 or 94060. It has specific criteria for when performed. |
The cpt codes 94010 and 94060 cannot be billed with 94375.
The codes 94726, 94727, and 94729 may be billed with codes 94010, 94060, 94375, as applicable.
Code 94640 Pressurized or non-pressurized inhalation treatment for acute airway obstruction of sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)
Triple-S will recognize payment separately from code 94640 if the respiratory therapy service was for treatment of acute bronchospasm or for the induction of sputum production for diagnostic purposes. It will not be recognized for payment if the respiratory therapy service was performed as part of the spirometry test protocol (Ex: In spirometries with bronchodilator response where a pre and post bronchodilator spirometry is performed).
When the patient's condition warrants billing of code 94375 and code 94640, the latter must be billed with MOD 59 in the form 1500 or electronically. The payment of this service will be subject to audit. Documentation that justifies payment separately from the service billed with MOD 59 must be legible and available in the patient's file.
See Policy Statement
BlueCard/National Account Issues
N/A
The major types of pulmonary function tests (PFTs) are spirometry, spirometry before and after a bronchodilator, lung volumes, and quantitation of diffusing capacity for carbon monoxide. Additional PFTs, such as measurement of maximal respiratory pressures, flow-volume loops, submaximal exercise testing, and bronchoprovocation challenge, are useful in specific clinical circumstances.
In preparation for PFTs, bronchodilator medications are typically held so that bronchodilator response can be assessed after baseline spirometry.
Spirometry, the most readily available and useful pulmonary function test, measures the volume of air exhaled at specific time points during a forceful and complete exhalation after a maximal inhalation. The total exhaled volume, known as the forced vital capacity (FVC), the volume exhaled in the first second, known as the forced expiratory volume in one second (FEV1), and their ratio (FEV1/FVC) are the most important variables reported. The test takes 10 to 15 minutes and carries minimal risk (e.g., rarely syncope). The technique for performing spirometries and interpretation of the results are described separately. (See "Office spirometry" and "Flow-volume loops".)
Spirometry is a key diagnostic test for asthma and chronic obstructive pulmonary disease (COPD) (when performed before and after bronchodilator) and is useful to assess for asthma or other causes of airflow obstruction in the evaluation of chronic cough. It is also used to monitor a broad spectrum of respiratory diseases, including asthma, COPD, interstitial lung disease, and neuromuscular diseases affecting respiratory muscles.
Flow-volume loop — Flow-volume loops, which include forced inspiratory and expiratory maneuvers, are performed whenever stridor is heard over the neck and for evaluation of unexplained dyspnea. Airway obstruction located in the pharynx, larynx, or trachea (upper airways) is usually impossible to detect from standard FVC maneuvers. Reproducible forced inspiratory vital capacity (FIVC) maneuvers may detect variable extra thoracic upper airway obstruction, as can be seen with vocal fold paralysis or dysfunction, which causes a characteristic limitation of flow (plateau) during forced inhalation but little if any obstruction during exhalation.
Lung volumes — Measurement of lung volumes is important when spirometry shows a decreased forced vital capacity. Body plethysmography is the gold standard for measurement of lung volumes, particularly in the setting of significant airflow obstruction. Alternative methods include helium dilution, nitrogen washout, and measurements based on chest imaging. Helium dilution and nitrogen washout may underestimate lung volume in patients with moderate to severe COPD because they do not access under or nonventilated areas.
Measurements of total lung capacity (TLC) using the chest radiograph or high-resolution computed tomography (HRCT) correlate within 15 percent of those obtained by body plethysmography.
N/A
Population Reference No. 1 Policy Statement
In patients with pulmonary obstructive disease, Most pulmonary problems can be grouped in those conditions that affect the expansion of the lung (restrictive) and those where there is increased resistance to the passage of air (obstructive). Both conditions can affect the exchange of gases, the main physiological function of the respiratory system. In addition to classifying pulmonary diseases as restrictive, obstructive or mixed, pulmonary function studies are useful in determining the severity of the lung condition in a certain disease, monitoring its progress, and evaluating the effect of its treatment.
Population Reference No. 1 Policy Statement | [X ] MedicallyNecessary | [ ] Investigational | [ ] Not Medically Necessary |
N/A
N/A
N/A
1. Medicare Coverage Database: LCD for Pulmonary Diagnostic Services (L33705)
2. Donald F. Dexter,MD Diplomate to the American Board of Pulmonary Diseases; Personal Communication
3. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26:319.
4. Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at predicting restrictive pulmonary impairment? Chest 1999; 115:869.
5. Tashkin DP, Celli B, Decramer M, et al. Bronchodilator responsiveness in patients with COPD. Eur Respir J 2008; 31:742.
6. Modrykamien AM, Gudavalli R, McCarthy K, et al. Detection of upper airway obstruction with spirometry results and the flow-volume loop: a comparison of quantitative and visual inspection criteria. Respir Care 2009; 54:474.
7. Washko GR, Hunninghake GM, Fernandez IE, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011; 364:897.
8. Crapo RO. Pulmonary-function testing. N Engl J Med 1994; 331:25.
9. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26:948.
10. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014; 44:1428.
11. Crapo RO. Pulmonary-function testing. N Engl J Med 1994; 331:25.
12. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26:948.
13. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014; 44:1428.
14. Wise RA, Brown CD. Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test. COPD 2005; 2:125.
15. Parreira VF, Janaudis-Ferreira T, Evans RA, et al. Measurement properties of the incremental shuttle walk test. a systematic review. Chest 2014; 145:1357.
16. Probst VS, Hernandes NA, Teixeira DC, et al. Reference values for the incremental shuttle walking test. Respir Med 2012; 106:243.
17. Harrison SL, Greening NJ, Houchen-Wolloff L, et al. Age-specific normal values for the incremental shuttle walk test in a healthy British population. J Cardiopulm Rehabil Prev 2013; 33:309.
18. Singh SJ, Morgan MD, Scott S, et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47:1019.
19.Singh SJ, Jones PW, Evans R, Morgan MD. Minimum clinically important improvement for the incremental shuttle walking test. Thorax 2008; 63:775.
20. Win T, Jackson A, Groves AM, et al. Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer. Thorax 2006; 61:57.
21. Revill SM, Morgan MD, Singh SJ, et al. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax 1999; 54:213.
22. Singh SJ, Morgan MD, Hardman AE, et al. Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J 1994; 7:2016.
23. Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg 2007; 105:S18.
24. Van der Molen T, Østrem A, Stallberg B, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma. Prim Care Respir J 2006; 15:35.
6. 25. Pulmonary function testing, Meredith C McCormack, MD, MHS, James K Stoller, MD, MS Up to Date Aug 2019
1. 26. Helen Hollingsworth, MD Up to Date.
| Codes | Number | Description |
| | 94010 | Spirometry, including graphic record, total and time vital capacity expiratory flow rate measurement(s), and/or maximal voluntary ventilation. |
| | 94060 | Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator (aerosol and parenteral) or exercise. |
| | 94070 | Prolonged post exposure evaluation of bronchospasm with multiple spirometric determinations after test dose of bronchodilator (aerosol only) antigen, excercise, cold air, methacholine or other chemical agent, with spirometry as in 94010. |
| | 94150 | Vital capacity, total (separate procedure). |
| | 94200 | Maximum breathing capacity, maximal voluntary ventilations. |
| Terminated 12/31/2020. No Substitutes. | 94250
| Expired gas collection quantitative, single procedure (separate procedure).
|
| | 94726 | Plethysmography for determination of lung volumes, and when performed,,airway resistance |
| | 94727 | Gas dilution or washout for determination of lung volumes and,when performed,distribution of ventilation and closing volumes |
| | 94728 | Airway resistance by impulse oscillometry |
| | 94375 | Respiratory flow volume loop |
| Terminated 12/31/2011. Replaced with 94618 Effective 01/01/2018. | 94620
| Pulmonary stress testing, simple or complex.
|
| | 94621 | Complex (including measurements of C02 production, 02 uptake, and electrocardiographic recordings) |
| | 94729 | Diffusing capacity (Eg. Carbon monoxide, membrane) |
| Terminated 12/31/2020. No Substitues. | 94750
| Pulmonary compliance study, (Eg.pletysmography,volume and pressure measurement)
|
| Terminated 12/31/2020. No Substitutes. | 94770
| Carbon dioxide expired gas determination by infrared analyzer.
|
| Terminated 12/31/2020. No Substitutes. | 94400
| Breathing response to C02 (C02 response curve)
|
| | 94450 | Breathing response to hypoxia (hypoxia response curve) |
| ICD-10-CM (effective 10/1/15) | B44.81 | Allergic bronchopulmonary aspergillosis |
| | B90.9 | of respiratory and unspecified tuberculosis Sequelae of respiratory and unspecified tuberculosis |
| | C33 | Malignant neoplasm of trachea |
| | C34.00 | Malignant neoplasm of unspecified main bronchus |
| | C34.01 | Malignant neoplasm of right main bronchus |
| | C34.02 | Malignant neoplasm of left main bronchus |
| | C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| | C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| | C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| | C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| | C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| | C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| | C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| | C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| | C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| | C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| | C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| | C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| | C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| | C78.00 | Secondary malignant neoplasm of unspecified lung |
| | C78.01 | Secondary malignant neoplasm of right lung |
| | C78.02 | Secondary malignant neoplasm of left lung |
| | C78.30 | Secondary malignant neoplasm of unspecified respiratory organ |
| | C78.39 | Secondary malignant neoplasm of other respiratory organs |
| | D14.2 | Benign neoplasm of trachea |
| | D18.1 | any site Lymphangioma, any site |
| | D14.30 | Benign neoplasm of unspecified bronchus and lung |
| | D14.31 | Benign neoplasm of right bronchus and lung |
| | D14.32 | Benign neoplasm of left bronchus and lung |
| | D57.01 | Hb-SS disease with acute chest syndrome |
| | D57.211 | Sickle-cell/Hb-C disease with acute chest syndrome |
| | D57.411 | Sickle-cell thalassemia with acute chest syndrome |
| | D57.811 | Other sickle-cell disorders with acute chest syndrome |
| | D86.0 | Sarcoidosis of lung |
| | D86.1 | Sarcoidosis of lymph nodes |
| | D86.2 | Sarcoidosis of lung with sarcoidosis of lymph nodes |
| | D86.3 | Sarcoidosis of skin |
| | D86.81 | Sarcoid meningitis |
| | D86.82 | Multiple cranial nerve palsies in sarcoidosis |
| | D86.83 | Sarcoid iridocyclitis |
| | D86.84 | Sarcoid pyelonephritis |
| | D86.85 | Sarcoid myocarditis |
| | D86.86 | Sarcoid arthropathy |
| | D86.87 | Sarcoid myositis |
| | D86.89 | D86.89 Sarcoidosis of other sites |
| | D86.87 | Sarcoid myositis |
| | D86.9 | Sarcoidosis, unspecified |
| | E84.0 | Cystic fibrosis with pulmonary manifestations |
| | E84.19 | E84.19 Cystic fibrosis with other intestinal manifestations |
| | E71.41 | carnitine deficiency Primary carnitine deficiency |
| | E71.42 | deficiency due to inborn errors of metabolism Carnitine deficiency due to inborn errors of metabolism |
| | E71.43 | carnitine deficiency Iatrogenic carnitine deficiency |
| | E71.448 | secondary carnitine deficiency Other secondary carnitine deficiency |
| | G02 | Meningitis in other infectious and parasitic diseases classified elsewhere |
| | G47.30 | Sleep apnea, unspecified |
| | G83.81 | syndrome Brown-Sequard syndrome |
| | G83.84 | paralysis (postepileptic) Todd's paralysis (postepileptic) |
| | G83.89 | specified paralytic syndromes Other specified paralytic syndromes |
| | G60.9 | and idiopathic neuropathy, unspecified Hereditary and idiopathic neuropathy, unspecified |
| | I26.01 | Septic pulmonary embolism with acute cor pulmonale |
| | I26.02 | Saddle embolus of pulmonary artery with acute cor pulmonale |
| | I26.09 | Other pulmonary embolism with acute cor pulmonale |
| | I26.90 | Septic pulmonary embolism without acute cor pulmonale |
| | I26.92 | Saddle embolus of pulmonary artery without acute cor pulmonale |
| | I26.99 | Other pulmonary embolism without acute cor pulmonale |
| | J17 | Pneumonia in diseases classified elsewhere |
| | J18.8 | Other pneumonia, unspecified organism |
| | J18.9 | Pneumonia, unspecified organism |
| | R05.1 | Acute Cough |
| | R05.2 | Subacute Cough |
| | R05.3 | Chronic Cough |
| | R05.8 | Other specified cough |
| | R05.9 | Cough, unspecified |
Some modifiers
| Date | Action | Description |
| 11/04/2022 | Replace Review | Diagnosis added: R05.1, R05.2, R05.3, R05.8, R05.9. Terminated Codes: Terminated 94250 by 12/31/2020
Terminated 94620 by 12/31/2017. Replaced with 94618 effective 01/01/2018.
Terminated 94750 by 12/31/2020
Terminated 94770 by 12/31/2020
Terminated 94400 by 12/31/2020 |
| 11/14/2019 | Annual Review. Policy Archived. | Reviewed by the Providers Advisory Committee. Recommends archiving the policy. |
| 11/14/2018 | Annual Review | No changes |
| 11/16/2017 | Annual Review | No changes |
| 09/27/2016 | | |
| 12/3/2015 | | |
| 5/11/2015 | | |
| 12/14/2011 | | |
| 05/14/2009 | | |
| 04/08/2009 | | |