Procedure Complexity
PFT, bronchoscopy and pulmonary rehab each carry their own documentation and bundling rules. Generalist coders misapply them constantly.
Specialty-Specific RCMPulmonology
Pulmonology
Billing Services
Revix MD handles medical billing for pulmonary clinics, respiratory care practices, hospitals and specialty groups across the U.S. – coded around the procedure complexity, payer rules and documentation standards specific to this specialty.
The Challenge
Pulmonology Revenue Gets Lost in the Details
Pulmonary medicine combines diagnostic testing, chronic disease management and procedural intervention into a single billing workflow, and each category carries its own rules. Most denials trace back to one of five pressure points.
Full Revenue Cycle Coverage
Front-end to back-end, as one workflow
Most denials originate before a claim is ever filed. Revix MD owns both halves of the cycle together, not as two disconnected vendors.
Specialty Services
Built Around Every Major Pulmonary Procedure and Code Set
As a dedicated pulmonary function test billing company and respiratory billing partner, our coding depth runs across every major pulmonary service line, not a generic specialty checklist.
CPT 94010–94799
Pulmonary Function Test Billing
Accurate billing for pulmonary function tests and spirometry, including pre- and post-bronchodilator testing. We correctly split and append Professional and Technical components (Modifier 26 and Modifier TC) for split-billing environments, so you’re fully reimbursed for both technical throughput and physician interpretation.
CPT 31622–31645
Bronchoscopy Billing Services
Coding support for diagnostic and therapeutic procedures, biopsy components and add-on codes. Our coders check every bronchoscopy claim against NCCI edit pairs before submission, apply multiple-procedure modifiers correctly for multi-lesion biopsies, and catch the unbundling errors that trigger rejections.
DME & NCD 240.2
Respiratory Equipment & Oxygen Therapy Billing
Full-service billing support for home respiratory equipment under complex Medicare guidelines. We track capped rental rules, the 36-month oxygen equipment ceiling, and verify the Certificate of Medical Necessity (CMN) at initial setup. Medicare requires a qualifying arterial blood gas or oximetry study under NCD 240.2 before approving home oxygen claims. We confirm that documentation before the claim goes out.
ICD-10 J00–J99
Chronic Respiratory Disease Billing: COPD and Asthma
Reimbursement support for chronic respiratory disease populations. We protect your practice from audit triggers on COPD (ICD-10 J44.0 through J44.9) and asthma (ICD-10 J45.20 through J45.998) claims through precise severity documentation. E/M levels stay aligned with the complexity of concurrent clinical testing, which is where most severity-based undercoding happens.
Sleep Medicine Billing
A lot of pulmonology practices run their own sleep labs. We handle that billing through a dedicated service line built for polysomnography coding, CPAP/BiPAP authorization and Medicare compliance tracking.
Who We Support
Pulmonary Practices We Support
Revix MD supports pulmonary organizations with specialty-specific billing workflows designed around complex respiratory procedures, payer requirements, and documentation standards.
Regulatory & Coding Authority
Governed by Absolute Clinical Precision
Our coders work directly within the frameworks that govern pulmonary reimbursement, CMS coverage criteria for pulmonary rehabilitation under NCD 240.8 and NCD 240.9, applicable Local Coverage Determinations (LCDs) for spirometry and bronchoscopy coverage, and the prior authorization standards specific to pulmonary rehab programs and respiratory biologics.
ICD-10 J00–J99
Bronchoscopy Billing Services
Under NCD 240.8, CMS covers up to 36 one-hour pulmonary rehabilitation sessions over 36 weeks. An additional 36 sessions are allowed only through the KX modifier and documented medical necessity per NCD 240.9. We track each patient’s session count and modifier requirements so claims go out correctly the first time.
American Thoracic Society (ATS)CHESTGOLD GuidelinesCMS NCD 240.8 / 240.9
Software & EHR Integration
Embedded Into The Systems You Already Run
Revix MD connects directly to your existing pulmonary EMR and specialty workflow environment – no migration, no dual data entry, no disruption to your clinical staff.
Pulmonary EMR Compatibility
Native connectivity with systems practices run.
EpicCareCloudathenahealtheClinicalWorks
HL7 / FHIR Connectivity
Secure, bidirectional clinical-to-billing data exchange that keeps documentation and coding synchronized in real time.
ANSI 837 / 835 Processing
Standardized claim submission and remittance processing, built around payer-specific edits.
Secure Reporting Access
Real-time dashboards for claim status. All data is HIPAA-compliant, encrypted end-to-end.
Get Started
Find Out What Your Practice Is Actually Owed
Request a free pulmonology billing audit. We’ll review your denial trends, A/R aging and coding accuracy across PFT, bronchoscopy and respiratory DME. If revenue is leaking, we’ll show you where.
Frequently Asked Questions
What is included in pulmonology medical billing services?
Pulmonology billing covers the full revenue cycle as one workflow, not two disconnected halves. That means eligibility verification, prior authorizations for pulmonary rehab and respiratory biologics, PFT and bronchoscopy coding, clean claim submission, denial management and payment posting.
How is pulmonary function test billing different from general billing?
PFT billing means managing pre- and post-bronchodilator testing and correctly split-billing technical and professional components with Modifier 26 and Modifier TC across CPT 94010–94799. Generalist teams frequently misapply or bundle these codes, leading to underpayment or audits.
What CPT codes are used for bronchoscopy billing?
Bronchoscopy billing primarily uses CPT 31622-31645. Accurate reimbursement depends on differentiating diagnostic versus therapeutic procedures, capturing surgical biopsy components, and applying multiple-procedure modifiers correctly to avoid compliance risk and improper unbundling rejections.
How do you bill for oxygen therapy under Medicare?
Oxygen therapy billing requires specific HCPCS codes (E0424–E0466, E0601, E0470, E1390) and is governed by capped rental rules and the 36-month oxygen equipment ceiling. Claims are rejected without a verified Certificate of Medical Necessity from initial setup.
What causes the most claim denials in pulmonology billing?
Incomplete documentation for medical necessity is the biggest one. After that, missing prior authorizations for pulmonary rehab and respiratory biologics, unbundling errors across overlapping CPT ranges, and payer-specific session limits for rehab claims that go untracked until the denial shows up 60 days later.
When do you use Modifier 25 vs. Modifier 59 on pulmonology claims?
Modifier 25 applies when a physician performs a separately identifiable E/M visit on the same day as a procedure, like an office visit on the same day as a PFT. Modifier 59 applies when two procedures that normally bundle were actually performed as distinct services, at different sites or during separate encounters. We review same-day claims before submission to apply the correct modifier and avoid automatic payer bundling edits.
How much do pulmonology billing services cost?
Revix MD uses a percentage-of-collections model. You pay based on what we actually collect, not a flat monthly retainer. There are no setup fees and no long-term contracts.