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Pulmonology Medical Billing service

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 encompasses 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 Procedures:

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


Treatment Services:

Billing for treatments such as oxygen therapy, nebulizer treatments, pulmonary rehabilitation, and medication management specific to respiratory diseases.


Chronic Care Management (CCM):

Billing for on-going management and coordination of care for patients with chronic respiratory conditions, ensuring compliance with CCM guidelines.


Coding and documentation:

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

Issues encountered by Pulmonologists in Pulmonology Billing


Pulmonologists often encounter several challenges in medical billing, including:

Coding Complexity:

The complexity of coding guidelines and frequent updates can lead to coding errors, denials, and delayed payments if not managed effectively.


Prior Authorization Requirements:

Some procedures and treatments in pulmonology may require prior authorization from payers, leading to administrative burdens and delays in patient care if not handled efficiently.


Claim Denials and Rejections:

Incorrect coding, incomplete documentation, and non-compliance with payer policies can result in claim denials or rejections, impacting revenue flow 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 Utilization of Inhaler or Nebulizer:

94799 – Unlisted Pulmonary Service or Procedure: This code is used for reporting pulmonary services or procedures that do not have specific CPT codes. It requires detailed documentation describing the service or procedure performed. We thoroughly reviews documentation for unlisted pulmonary services or procedures, working closely with providers to gather comprehensive information about the service, its complexity, and any associated resources utilized. We apply the appropriate modifiers, such as Modifier 22 (Increased Procedural Services), if the service required additional work or complexity beyond the norm, facilitating proper reimbursement.


99291/99292 Critical Care Services:

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


96413/96417 – Chemotherapy Administration Codes:

Pulmonologists may administer chemotherapy drugs as part of treating 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 for reporting these services.

How DoctorsBackOffice Expertise Takes Care of Pulmonology Billing ?


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

Here’s how we address the pain points faced by pulmonologists:


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 reimbursements.


Claim Submission and Follow-Up:

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


Compliance and Revenue Optimization:

We stay updated with industry regulations and payer policies, ensuring compliance and identifying opportunities to enhance revenue through proper coding and billing practices.


Transparent Reporting:

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


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 processes and achieve optimum reimbursements, financial stability, and practice growth.