Pulmonology Medical Billing Service

Pulmonology is a critical medical specialty focused on diagnosing and treating respiratory diseases and conditions. As pulmonologists dedicate their expertise to improving patients’ respiratory health, it’s crucial for them to have seamless and efficient medical billing processes.

Scope of Work in Pulmonology Medical Billing

The scope of pulmonology medical billing covers a wide range of services and procedures, including but not limited to:

Evaluation and Management (E/M) Services:

Billing for office visits, consultations, and follow-up appointments where pulmonologists assess and manage patients’ respiratory health.

Diagnostic Process:

Billing for diagnostic tests such as pulmonary function tests (PFTs), bronchoscopies, imaging studies (X-rays, CT scans) and sleep studies to accurately diagnose breathing conditions.

Treatment Service:

Billing for treatments such as oxygen therapy, nebulizer therapy, pulmonary rehabilitation, and management of certain medications for respiratory diseases.

Chronic Care Management (CCM):

Billing for ongoing management and coordination of care for patients with chronic respiratory conditions, ensuring adherence to CCM guidelines.

Coding and Documentation:

Accurate coding of services using CPT, HCPCS, and ICD-10 codes for pulmonology procedures and conditions, with comprehensive documentation to support medical necessity and billing accuracy.

Problems encountered by pulmonologists in pulmonology billing

 

Pulmonologists often face several challenges in medical billing, including:

Coding Complexity:

The complexity and frequent updates of coding guidelines can lead to coding errors, rejections, and delays if not managed effectively.

 

Prior Authorization Requirement:

Certain procedures and treatments in pulmonology may require prior authorization from payers, which creates administrative burdens and delays in patient care if not handled efficiently.

Denial and Denial of Claims:

Incorrect coding, incomplete documentation, and noncompliance with payer policies can result in claim denials or denials, revenue streams, and practice profitability.

 

Revenue Cycle Management:

Managing the entire revenue cycle, from claim submission to payment posting and follow-up on unpaid claims, requires dedicated resources and expertise to optimize revenue collection.

Some examples of CPT codes and how we manage them effectively:

99214 Evaluation and Management (E/M) Code with Modifier 25:

94664 – Demonstration and/or Evaluation of Patient Use of Inhalers or Nebulizers:

94799 – Unlisted pulmonary service or procedure: This code is used to report pulmonary services or procedures that do not have a specific CPT code. Detailed documentation describing the service or procedure is required. We conduct a thorough review of documentation for unlisted pulmonary services or procedures, working closely with providers to gather comprehensive information about the service, its complexity, and any associated resources used. We apply an appropriate modifier, such as Modifier 22 (Increased Procedural Services), if the service requires additional work or greater complexity than the norm, to facilitate appropriate reimbursement.

99291/99292 Critical Care Services:

Critical care services in pulmonology involve high complexity and intensive medical management for critically ill patients. CPT codes 99291 (critical care, first 30-74 minutes) and 99292 (critical care, every additional 30 minutes) are used to report these services.

96413/96417 – Chemotherapy Administration Code:

A pulmonologist may prescribe chemotherapy drugs as part of treatment for respiratory conditions or lung cancer. CPT codes 96413 (chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and 96417 (each additional sequential infusion of a different substance/drug) are used to report these services.

How Does DoctorsBackOffice Expertise Take Care of Pulmonology Billing ?

 

DoctorsBackOffice is your ideal partner for pulmonology medical billing services due to our expertise and commitment to deliver optimal results.

Here’s how we address the pain points pulmonologists face:

 

Accurate coding and documentation:

Our experienced coders and billers ensure accurate coding and comprehensive documentation, reducing errors and improving claim acceptance rates.

 

Prior Authorization Management:

We handle prior authorizations efficiently, ensuring timely approvals and minimizing delays in patient care and reimbursement.

 

Claim submission and follow-up:

Our team submits claims promptly, tracks their status and follows up on unpaid or rejected claims, optimizing the revenue cycle and maximizing collections.

 

Compliance and Revenue Optimization:

We stay updated with industry regulations and payment policies to ensure compliance and identify opportunities to increase revenue through proper coding and billing practices.

 

Transparent reporting:

We provide transparent reporting and analytics, giving you insight into key performance indicators, revenue trends, and areas for improvement in your billing process.

Outsourcing pulmonology billing to DoctorsBackOffice allows pulmonologists to focus on delivering high-quality patient care while we handle the complexities of billing and revenue management with expertise and precision. Partner with us today to streamline your pulmonology billing process and achieve optimal reimbursement, financial stability, and practice growth.