Medical Billing for Pulmonology Practices

Pulmonology Billing That Pays What You Earn

Pulmonology billing spans pulmonary function testing, bronchoscopy procedures, sleep medicine, and critical care — all with distinct coding requirements. PFT interpretation billing, bronchoscopy add-on codes, and sleep study coding are routinely undercoded by practices without pulmonology billing specialists. 360Solutions provides certified pulmonology coders who capture the full value of diagnostic procedures, critical care time, and sleep medicine services.

26%
avg pulmonology revenue lost to procedure undercoding
$420
avg additional revenue per bronchoscopy with correct add-ons
94%
first-pass rate for PFT and sleep study claims
Pulmonology Billing Challenges
Where practices lose the most revenue:
Pulmonary Function Testing
Bronchoscopy Add-On Codes
Sleep Study Coding
Critical Care Time Billing
Pulmonology Billing Challenges

Where Pulmonology Practices Lose Revenue

These are the coding and billing pitfalls that cost pulmonology practices the most — and where our specialised billers add the most value.

Pulmonary Function Testing

PFT codes (94010–94070) vary by which spirometry components are performed — pre/post bronchodilator, diffusion capacity, lung volumes. Billing only the basic spirometry when a full panel was performed leaves significant money uncaptured.

Bronchoscopy Add-On Codes

Bronchoscopy procedures (31622–31654) include numerous add-on codes for BAL, biopsy, brushing, foreign body removal, and navigation bronchoscopy. Each additional service must be coded with the correct add-on — generalist coders routinely miss them.

Sleep Study Coding

Polysomnography codes (95808–95811) depend on the number of monitored parameters and whether the study was attended. HSAT (home sleep apnea testing) uses different codes (95800–95801) with different documentation requirements.

Critical Care Time Billing

Pulmonologists in ICU settings bill critical care (99291/99292) based on time spent in direct patient management. Time must be documented separately from procedure time. Our billers track and reconcile critical care time against hospital records.

Coding Intelligence

High-Risk CPT Groups

Code ranges payers audit most aggressively in Pulmonology.

94010–94070
Pulmonary function testing — spirometry, diffusion, bronchospasm eval
31622–31654
Bronchoscopy — diagnostic, biopsy, BAL, navigation, thermoplasty
95808–95811
Polysomnography — attended, by age and monitored channels
95800 / 95801
Home sleep apnea testing — with/without respiratory effort
99291 / 99292
Critical care — first 30–74 min / each additional 30 min
Denial Intelligence

Common Denial Patterns

Knowing these before submission is the difference between a 60% and a 96% first-pass rate.

PFT code does not match documented components in spirometry report

Bronchoscopy add-on code billed without required primary procedure code

Sleep study billed as attended when performed as unattended HSAT

Critical care time overlaps with separately billed procedure time

CPAP titration (95811) billed without diagnostic polysomnography on prior date

Free Denial Audit

Send us your last 90 days of remittance data — we'll identify your top 3 fixable denial sources at no cost.

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Our Process

How 360Solutions Works for Pulmonology Practices

01

Free 2-Week Billing Audit

We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.

02

Specialty Coder Assignment

You are paired with a coder trained specifically in pulmonology coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.

03

Parallel Billing Transition

We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.

04

Live KPI Dashboard

Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.

05

Weekly Account Manager Call

Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.

Pulmonology Billing FAQ

Questions From Pulmonology Practices

Electromagnetic navigation bronchoscopy (31627) and robotic-assisted bronchoscopy require specific add-on codes and documentation of the navigation system used. We verify payer coverage — some still consider robotic bronchoscopy investigational — before submission.
Yes. We maintain separate coding workflows for pulmonary diagnostic procedures and sleep medicine, ensuring the correct code set is applied for each service type and that sleep study technical and professional components are billed appropriately.
Durable medical equipment (CPAP, BiPAP, O2) requires separate HCPCS billing and prior auth. We coordinate with the DME supplier, obtain the required sleep study documentation, and manage the auth process to prevent equipment delivery delays.
Yes. RPM codes (99453, 99454, 99457) are applicable for CPAP therapy monitoring when the practice reviews compliance data monthly. We track qualifying time and bill the correct RPM codes to capture this often-missed revenue stream.
Ready to Fix Your Pulmonology Billing?

Start With a Free,
No-Obligation Audit

Two weeks, no contract. A certified pulmonology billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.