Specialized billing for pulmonary and sleep practices — PFTs, bronchoscopy, sleep study coding, critical care, and prior authorization by pulmonology billing experts. Serving practices nationwide across the United States.
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Spirometry, bronchodilator, diffusing capacity, and lung volumes billed with correct component and professional/technical rules.
In-lab polysomnography, CPAP titration, and home sleep tests coded to policy with authorization and testing-order rules.
Diagnostic bronchoscopy and its add-ons — biopsy, lavage, EBUS — coded against NCCI edits so distinct services are paid.
Time-based critical care (99291/99292) and inpatient services documented and protected from same-day bundling.
Managing authorization for sleep studies, advanced imaging, and biologics used in severe asthma and interstitial disease.
We appeal medical-necessity, bundling, and authorization denials and fix the front-end causes behind them.
Pulmonology is one of the more operationally complex specialties to bill because the revenue is spread across so many different service types — office E/M for chronic COPD and asthma, in-office diagnostic testing, procedures like bronchoscopy, sleep studies with their own authorization maze, and significant inpatient and ICU work. Each of those lives under different rules, and the specialty's diagnostic tests are especially prone to bundling and component-billing errors. Getting paid fully means treating each service line as its own discipline rather than running everything through a single template.
PFTs are the specialty's signature in-office revenue, and they are a bundling minefield. Spirometry (94010), spirometry with bronchodilator (94060), diffusing capacity (94729), and lung-volume studies each describe specific work, and the components have to be billed as the specific tests performed — not unbundled into separately reported pieces that trigger a CO-97, and not lumped when they should be separate. The professional/technical split matters too when the interpretation and the test are furnished or billed by different parties. We bill PFTs to exactly what was done, which is where a lot of pulmonology revenue quietly leaks.
Sleep studies carry two layers of difficulty: medical-necessity criteria and a required sequence. In-lab polysomnography (95810), CPAP titration (95811), and home sleep testing frequently require prior authorization, and many payers insist on a home sleep test before they will approve an in-lab study. Bill an in-lab study the payer expected to be preceded by a home test, and it denies for authorization or medical necessity regardless of the clinical reasoning. We manage the authorization and the testing order so the study that gets performed is the study that gets paid — a missing auth here shows up as CO-197.
Diagnostic bronchoscopy (31622) anchors a whole family of add-on procedures — transbronchial biopsy, brushing, bronchoalveolar lavage, endobronchial ultrasound — governed by NCCI edits. Some are separately payable with the appropriate modifier when distinct; others are inclusive to the base procedure. Reflexively unbundling them invites audit exposure; reflexively bundling them leaves money behind. We apply the edits per case, using an X{EPSU} modifier only where the documentation supports a genuinely distinct service.
Pulmonologists carry heavy inpatient and ICU responsibility, and critical care (99291/99292) is time-based, documentation-sensitive, and easy to lose to same-day bundling with procedures. Meanwhile the office book — COPD and asthma management, inhalation treatments (94640), oxygen coordination — runs on E/M that has to be leveled defensibly (our E/M code calculator supports that) and monitored for medical-necessity denials (CO-50) and frequency edits (CO-151). Across all of it we track the practice's denial rate so the pattern in any one service line surfaces before it costs a quarter.
Specialties that share pulmonology’s cardiopulmonary testing, sleep studies and oncology overlap.
Cardiopulmonary testing overlaps, and dyspnoea workups routinely bill across both specialties.
Sleep-disordered breathing is co-managed, with strict coverage criteria on sleep studies.
Lung cancer screening and diagnostic bronchoscopy precede the oncology episode.
Chest imaging and low-dose CT screening carry specific eligibility and frequency requirements.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Get a free billing audit and see how much more your pulmonology or sleep practice can collect.
Get Free Practice AuditFree resources: E/M Code Calculator | CO-97 — Bundling | CO-197 — Authorization | Denial Rate Calculator