Pulmonology Billing & RCM Expertise
Optimized billing services for respiratory and lung-related conditions—from sleep studies to critical care billing.
Our experienced billing experts support pulmonologists by ensuring accurate coding, pre-auth checks, and denial management for PFTs, CPAP therapy, ICU visits, and more.
Schedule a Free ConsultationAccurate Coding for Respiratory Conditions
We provide precise CPT and ICD-10 coding for chronic obstructive pulmonary disease (COPD), asthma, bronchitis, sleep apnea, and pulmonary function testing.
Common Pulmonary Diagnoses
- COPD (J44.9)
- Asthma (J45.909)
- Interstitial lung disease (J84.9)
- Pneumonia (J18.9)
- Pulmonary embolism (I26.99)
Evaluation & Management
- Office visits (99202-99215)
- Hospital visits (99221-99233)
- Critical care (99291-99292)
- Pulmonary rehab (G0424)
Sleep Study & PFT Billing
Specialized billing support for overnight polysomnography, CPAP titration, spirometry, and full pulmonary function testing — including pre-authorization and payer compliance.
Pulmonary Function Testing:
Sleep Study Services:
Critical Care & Inpatient Billing
Expert RCM for ICU visits, mechanical ventilation, oxygen therapy, and inpatient consults — with time-based documentation and proper modifier use.
Our Critical Care Billing Process:
- Verify time-based documentation meets requirements
- Apply correct critical care codes (99291-99292)
- Bundle procedures included in critical care
- Document medical necessity for extended time
- Coordinate with hospital billing for facility fees
Inpatient Procedures:
A/R Management and Denial Appeals
Our team proactively follows up on denied or underpaid claims for procedures such as bronchoscopy, thoracentesis, and lung biopsies — ensuring maximum collections.
Common Pulmonology Denials:
- Medical necessity for PFTs
- Frequency limits for sleep studies
- Documentation for critical care time
- Bundled bronchoscopy procedures
- CPAP supply documentation
Our A/R Recovery Process:
- Daily claim status monitoring
- Payer-specific appeal strategies
- Underpayment identification
- Clinical documentation review
- Monthly A/R aging reports
Pulmonology-Specific Modifiers
Proper modifier usage is critical for pulmonary billing. Our certified coders ensure correct application to prevent denials and maximize reimbursement.
| Modifier | Usage | Example |
|---|---|---|
| -26 | Professional component | Hospital interpretation of PFTs |
| -TC | Technical component | In-office spirometry |
| -59 | Distinct procedural service | Bronchoscopy with biopsy |
| -CR | Catastrophe/disaster related | COVID-19 related care |
DME Billing for CPAP & Oxygen
We handle all aspects of DME billing for respiratory equipment with proper documentation requirements:
CPAP/BIPAP
(E0601) with compliance documentation
Oxygen Therapy
(E0424-E0431) with qualifying test results
Supplies
(A7030-A7046) with proper frequency limits
What Pulmonologists Say
Dr. James Wilson
Advanced Pulmonary Associates
"Their expertise in critical care billing increased our collections by 25% while reducing our denial rate to under 4%. The detailed reports help us track documentation gaps."
Lisa M., Practice Administrator
Sleep & Lung Specialists
"They recovered $52,000 in underpaid sleep study claims we had missed. Their knowledge of pulmonary-specific coding is exceptional."
Pulmonology Billing FAQs
How do you handle billing for CPAP compliance?
We track compliance documentation (4+ hours/night for 70% of nights) and ensure proper billing for CPAP supplies (A7034-A7046) within Medicare frequency limits. Our system flags when compliance documentation is due for re-submission.
What's your approach to critical care time documentation?
We verify documentation clearly shows time spent exclusively managing the critical illness, with start/stop times and activities performed. Our coders ensure time is properly calculated and doesn't overlap with separately billable procedures.
How do you stay current with pulmonary-specific coding changes?
Our team attends ATS and CHEST coding workshops, reviews CMS transmittals affecting pulmonary codes, and participates in specialty-specific training. We provide quarterly updates to clients on coding changes impacting pulmonology practices.