Revenue problems in pulmonology practices rarely start in the exam room. They start in the billing department, quietly and consistently, often without anyone noticing until the numbers tell the story at the end of the quarter.
A denied claim here. An underpayment there. A resubmission that takes three weeks and still comes back wrong. Individually, these feel like minor inconveniences. Collectively, they represent real revenue that a practice earned and didn’t collect.
Why Pulmonology Billing Is Harder Than Most Specialties
Pulmonology sits in a complicated corner of medical billing. Conditions like COPD, asthma, interstitial lung disease, lung cancer and pulmonary hypertension carry complex, layered diagnoses that require coding precision most general billing teams aren’t equipped to handle confidently.
Then there are the procedures. Pulmonary function testing, bronchoscopy, thoracentesis, lung biopsy and pulmonary rehabilitation each carry their own CPT code requirements, documentation standards and payer-specific rules. A bronchoscopy billed without the correct modifier. A pulmonary rehabilitation session coded without supporting documentation. A diagnosis code that’s one level too vague. Each of these creates a downstream problem that takes significantly more time to fix than it would have taken to get right the first time.
Pulmonology billing also sits directly in the crosshairs of regulatory change. ICD-10 updates, shifting Medicare guidelines and payer policy revisions mean the rules governing a claim submission last year may not apply the same way this year. Practices that aren’t actively tracking these changes end up submitting claims that were once accurate and no longer are. Prior authorization requirements add another layer of complexity and navigating those correctly is just as important as the coding itself.
What Accurate Pulmonology Billing Actually Requires
Diagnosis Coding That Holds Up to Scrutiny
The ICD-10 codes used in pulmonology need to be specific. The difference between J44.9 (COPD, unspecified) and a more detailed code that captures severity and related complications is often the difference between a claim that processes cleanly and one flagged for additional documentation.
Every diagnosis code should reflect exactly what the patient presented with, what was found and what was treated. Vague coding risks denial and creates a medical record that doesn’t accurately represent the care delivered.
Procedure Coding That Captures the Full Scope of Care
Pulmonology procedures are detailed and the CPT codes covering them reflect that. Spirometry isn’t just CPT 94010. How it was performed, whether additional testing was done in the same session and what the clinical findings were all influence how the claim should be structured.
Below are commonly billed CPT codes in pulmonology and what each requires to process correctly:
| CPT Code | Procedure | Key Billing Consideration |
| 94010 | Spirometry | Must document pre and post bronchodilator testing if performed in same session |
| 94060 | Spirometry with bronchodilator | Requires separate documentation from 94010 if billed together |
| 31622 | Flexible bronchoscopy with biopsy | Modifier required when combined with other same-session procedures |
| 94625 | Pulmonary rehab (physician supervision) | Requires documented treatment plan and physician presence |
| 94624 | Pulmonary rehab (without physician) | Supporting documentation must justify level of supervision |
| 32408 | Lung biopsy (percutaneous) | Imaging guidance code must be billed separately if applicable |
Getting these consistently right requires familiarity with pulmonology specifically, not just general medical coding experience.
Modifier Use That Reflects Clinical Reality
Modifiers are where a significant amount of pulmonology billing revenue gets left on the table. Modifier 25, used when a significant evaluation and management service is provided on the same day as a procedure, is frequently underapplied. Modifier 59, which distinguishes separately identifiable procedural services, is often missed when multiple services are provided in a single encounter.
These aren’t technicalities. They’re the difference between being reimbursed for the full scope of care delivered and being reimbursed for a fraction of it.
What Happens When Billing Falls Short
The financial impact of weak pulmonology billing shows up in predictable ways:
- Claim denial rates climb as coding inconsistencies accumulate across submissions
- Accounts receivable days stretch out, putting pressure on monthly cash flow
- Staff time shifts toward resubmissions and appeals rather than front-end accuracy
- Payer audits become more likely as patterns of inconsistent coding draw attention
- Medical records become less reliable as clinical documentation, affecting care continuity beyond billing
Most of these outcomes trace back to the same root causes incomplete documentation, vague coding and missed modifiers. Identifying those root causes of denial and building a structured appeals process around them is what separates practices that recover denied revenue from those that absorb the loss.
The Case for Outsourcing Pulmonology Billing Services
Many practices choose to work with a dedicated pulmonology billing services provider because the specialty demands a level of familiarity that general billing teams rarely develop on their own. Specialists work with these codes every day, track regulatory changes as they happen and identify errors before they become denied claims.
Real-time claim monitoring means problems get flagged quickly rather than discovered weeks later. For practices where billing staff are stretched across multiple responsibilities, outsourcing often results in fewer denials, faster reimbursement and more time directed toward patient-facing work.
What Specialist Pulmonology Billing Typically Covers
A billing team focused on pulmonology generally handles the full scope of the revenue cycle management process, including:
- ICD-10 diagnosis coding for both chronic and acute pulmonary conditions
- CPT and HCPCS code application across the full range of pulmonology procedures
- Modifier review to capture the complete scope of care delivered in each encounter
- Denial management and appeal handling for rejected or underpaid claims
- Prior authorization coordination to prevent denials before claims are submitted
- Eligibility verification to confirm coverage ahead of procedures
The scope varies by provider, but the underlying goal is consistent: claims that accurately reflect the care delivered and are submitted correctly the first time.
For practices looking to tighten up their pulmonology billing, MedLife MBS works with respiratory care practices across specialties and can be a useful starting point for assessing where revenue is being lost.