Master Pulmonary Function Test (PFT) bundling, reduce preventable sleep study denials, and secure ICU critical care reimbursement.
Pulmonology is a subspecialty of internal medicine that focuses on the health of the respiratory system—including the lungs, airways, and respiratory muscles. Pulmonologists diagnose and treat conditions such as asthma, COPD, pulmonary fibrosis, lung cancer, sleep apnea, and acute respiratory distress in the ICU.
Across a modern pulmonology practice, the clinical scope may include PFTs; Sleep medicine; Bronchoscopy/EBUS; COPD/asthma/interstitial lung disease; ICU pulmonary critical care. That breadth creates different documentation, coding, authorization, payer, and follow-up pathways—so the revenue cycle should never be treated as a generic claim-submission workflow.
Pulmonology billing spans outpatient Evaluation and Management, office diagnostic testing (Pulmonary Function Tests - PFTs), sleep medicine (polysomnography and home sleep apnea tests), interventional bronchoscopies, and high-acuity inpatient critical care in the Intensive Care Unit (ICU).
The risks below reflect the supplied Pulmonology content and should be evaluated against the practice’s actual payer mix, documentation and service setting.
Performing spirometry (CPT 94010), lung volumes (94726), and diffusion capacity (CPT 94729) on the same day as an E/M visit results in visit denials unless Modifier 25 is supported by distinct clinical documentation.
Diagnostic sleep studies and home sleep apnea testing can be denied for missing authorization, medical-necessity support, technical documentation, or payer-specific recording requirements.
Advanced bronchoscopies using Endobronchial Ultrasound (EBUS - CPT 31652/31653) or lung biopsies (CPT 31628) are often improperly unbundled from base bronchoscopy codes (CPT 31622), triggering payer audits.
Critical care visits shared between pulmonologists and Advanced Practice Providers (APPs) are clawed back if total cumulative time and substantive portion rules are not documented explicitly.
CareMedox's certified coding team supports Pulmonology through specialty-aware documentation and claim review, backed by senior RCM professionals experienced across 10+ specialties.
CareMedox uses documentation-first, payer-aware review rather than a one-rule-fits-all approach. Code selection, modifiers, units, place of service, authorization requirements, NCCI edits, medical necessity, and component billing are evaluated against the actual service and applicable payer rules.
Pulmonary function test coding and component rules
Sleep study and HSAT authorization/documentation
Bronchoscopy and EBUS procedure sequencing
Critical care 99291/99292 time rules
Split/shared critical-care documentation when applicable
Each issue is traced to the stage that created it, then worked through the appropriate coding, authorization, claim, posting, denial or AR workflow.
PFT components, same-day E/M documentation, professional/technical component rules, and Modifier 25 requirements are reviewed according to the code and payer.
Authorization, diagnosis/medical-necessity support, test type, recording/documentation requirements, and rendering/facility rules are checked before billing.
CareMedox certified coders sequence the documented bronchoscopic procedures using current bundling edits, site/lesion information, and modifier rules.
Qualifying critical-care time and work, split/shared rules when applicable, and separately reportable procedures are validated before 99291/99292 are submitted.
PFTs
Sleep medicine
Bronchoscopy/EBUS
COPD/asthma/interstitial lung disease
ICU pulmonary critical care
CareMedox connects each stage instead of treating coding, posting, denials and AR as isolated tasks.
Confirm active coverage, benefits and patient-responsibility information before the claim begins.
Identify and track payer authorization requirements when the service requires approval.
Review documentation, code selection, modifiers, units and specialty-specific claim dependencies.
Check claim structure, payer edits and known front-end issues before submission.
Release claims through the practice’s existing billing and clearinghouse environment.
Correct clearinghouse or payer front-end rejections before they become aged balances.
Post ERA/EOB activity, contractual adjustments, patient responsibility and corrections accurately.
Work payer denials from root cause through correction, reconsideration or appeal when supported.
Prioritize unresolved balances with attention to 60/90/120+ aging and deadline risk.
Explain claim, CPT, payment, denial, aging and collection changes in weekly/monthly reporting.
The specialty changes. The operating standards stay disciplined.
CareMedox combines certified coding review with senior revenue-cycle professionals who bring 5–6 years of hands-on experience in claim scrubbing, payment posting, AR follow-up and denial work.
Experienced RCM team members have worked across more than 10 specialties, helping CareMedox recognize payer and workflow patterns that a single-specialty-only billing desk may miss.
CareMedox can work inside the practice’s existing EHR, practice-management and billing environment. The senior team has experience across more than 15 platforms and different clearinghouses.
Old receivables are not treated as background noise. CareMedox prioritizes aging that is approaching appeal, timely-filing or recoverability risk and documents the action taken at claim level.
Reporting provides more than a top-line collection number. CareMedox can report payment activity, claim-level changes, CPT-level patterns, denials, aging, collection trends and the broader RCM picture.
If a prior-period collection included a duplicate or incorrect posting that later requires correction, CareMedox reports the correction transparently rather than hiding the change.
Where a claim becomes nonrecoverable solely because of CareMedox negligence, the CareMedox timely-filing policy applies according to the executed service agreement and applicable Medicare-fee-schedule basis.
The specialty audit should examine the practice's actual data for: Pulmonary Function Testing (PFT) Bundling Denials; Sleep Study (Polysomnography) Rejections; Interventional Bronchoscopy Bundling Errors; Shared/Split ICU Critical Care (CPT 99291/99292) Recoups; CPT-level and claim-level accuracy; rejection and denial patterns; 60/90/120+ aging; authorization leakage where relevant; posting/reconciliation issues; payer trends; and timely-filing exposure.
The purpose is to establish the practice's real baseline first, then show exactly where revenue is being delayed, denied, under-documented, incorrectly posted, under-followed, or placed at timely-filing risk.
CPT-level analysis
Claim-level analysis
First-pass and rejection review
Denial root-cause analysis
Collection comparison
Payment-posting and reconciliation review
60/90/120+ aging analysis
Authorization leakage where applicable
Timely-filing and appeal-deadline exposure
Payer-specific patterns
Coding/documentation risk patterns
Underpayments or unexplained payment changes where identifiable
Practice workflow analysis
Mistakes/findings report
Prioritized action plan
These answers explain CareMedox’s specialty workflow and how the revenue cycle is reviewed around the practice’s actual services and payer environment.
Pulmonology billing spans outpatient Evaluation and Management, office diagnostic testing (Pulmonary Function Tests - PFTs), sleep medicine (polysomnography and home sleep apnea tests), interventional bronchoscopies, and high-acuity inpatient critical care in the Intensive Care Unit (ICU).
CareMedox combines certified coding review, payer-specific claim scrubbing, authorization tracking when required, payment-posting reconciliation, and active AR follow-up. The workflow is built around the pulmonology risks described on this page rather than applying a generic specialty template.
Yes. CareMedox's senior billing team has hands-on experience across more than 15 EHR, practice-management, and billing platforms and can work with different clearinghouses. The transition is designed around the practice's existing workflow rather than forcing a software replacement.
The 30-day audit reviews CPT-level and claim-level patterns, collection performance, denials and rejections, aging, authorization issues where relevant, payment posting, payer behavior, and workflow mistakes. CareMedox then presents the findings so the practice can see where revenue-cycle performance can be improved.
Request a 30-Day Free Pulmonology Billing Audit and let CareMedox review the coding, claims, denials, aging, posting, and payer workflow behind your current collections.
A shorter first step when you want to discuss a billing, RCM, AR, denial, reporting or payer-workflow concern without completing the full inquiry form.
