SpecialtiesMedical specialties
How we see pulmonology billing.
Reviewed by the VisMed medical specialties billing team
A pulmonologist’s day can include a clinic of chronic lung disease, a set of pulmonary function tests, a bronchoscopy, ICU rounds with critical care time and a stack of oxygen and CPAP orders. Each is billed differently. PFTs have components and bundling rules. Bronchoscopy has add-on codes for what was done through the scope. Critical care is billed by minutes. Oxygen and DME depend on documented qualifying values and a face-to-face note that meets the supplier’s needs.
The visits themselves are complex chronic management, and the same undercoding pattern we see across internal medicine shows up here. Chronic care, remote monitoring and pulmonary rehabilitation supervision add recurring revenue that few practices capture.
For pulmonology, VisMed brings coders who know the PFT and bronchoscopy rules, a critical-care capture process for the hospital side, order templates that pass supplier review, and a program approach to the chronic population.
Where pulmonology practices lose money
The patterns we find in the aging and denial history before anything else changes.
PFT bundling and components
Spirometry, lung volumes, diffusion and bronchodilator responsiveness have combination codes and bundling edits. Billing them separately is denied; billing the wrong combination is paid short.Bronchoscopy add-ons missed
Biopsy, lavage, brushings, navigation and ultrasound guidance are add-ons to the base bronchoscopy. Reports that list them in prose without the coder catching them lose the lines.Critical care minutes undocumented
ICU rounds that qualify as critical care are billed by time. Without minutes in the note, the visit bills as a subsequent hospital visit.Oxygen and DME orders that fail supplier review
Qualifying saturation values, testing conditions and the face-to-face note have to meet payer rules or the supplier cannot bill and comes back to the practice.Chronic visits leveled low
COPD and interstitial disease management with medication changes and data review supports higher levels than are typically billed.
What we do differently for pulmonology
Specialty-matched coders and a denials specialist, working inside your own system.
We code PFTs by rule
We apply the combination codes and bundling edits per test battery at charge entry, matched to the lab report.We read every bronchoscopy report
Our coders read each report for add-on services and guidance before the claim leaves.We prompt for critical care
Hospital templates that prompt for time and the elements that support critical care, with a coder review of ICU encounters.We build DME order templates to payer criteria
Oxygen and PAP orders built to the payer’s qualifying criteria, so the supplier’s claim goes through and the order does not bounce.
What we bill
The procedure and code families your account team already works in.
Pulmonology billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
Why are our PFT claims paid less than expected?
Usually because the combination code that covers the whole battery was not used, or components were billed separately and bundled by the payer. VisMed matches the coding to the test report and the payer’s edits at charge entry.
Does VisMed capture critical care in the ICU?
Yes, from the note. Where the physician documents time and the elements of critical care, VisMed bills it; where the note is close, we query. Our templates make the minutes a one-line addition.
Our oxygen orders keep coming back from the supplier. Why?
The qualifying values or the face-to-face documentation did not meet the payer’s rules. VisMed builds order templates to those rules so the order is right the first time.
Can VisMed bill sleep testing for us?
Yes. Home sleep testing and interpretation, and in-lab studies where you have a lab, follow the same authorization and component rules VisMed runs for sleep medicine practices.
Does VisMed bill pulmonary rehabilitation supervision?
Where the practice supervises a pulmonary rehabilitation program, VisMed bills the supervision and session codes with the physician-presence and plan-of-care documentation the payer requires, and tracks session counts against coverage limits.
Also in medical specialties
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Diagnostics, device checks and cath-lab professional fees.
Endocrinology
CGM, infusion and chronic-condition management codes.
Gastroenterology
Endoscopy, ASC splits and screening-vs-diagnostic rules.
Hepatology
Infusions, specialty drugs and prior authorization.
Nephrology
Dialysis MCP, monthly capitation and transplant follow-up.
Rheumatology
Biologic infusions, J-codes and buy-and-bill.
Neurology
EEG/EMG, infusion and long-visit E/M.
Oncology
Chemotherapy administration, drugs and NDC reporting.
Hematology
Infusion and lab-linked visits.
Immunology & allergy
Testing panels and immunotherapy series.
Infectious disease
Inpatient rounds, long-term therapy and telehealth.
Dermatology
Lesion coding, pathology and cosmetic separation.
Pain management
Injections, ablations and strict authorization trails.
Psychiatry
Med-management with therapy add-ons, parity rules.
All specialties
The full list, in six groups
See where your pulmonology practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
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