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Comprehensive Guide to Office Spirometry for Respiratory Assessment

Learn about indications, contraindications, benefits, coding, reimbursement, equipment, techniques, terminology, interpretation, and documentation of office spirometry for evaluating respiratory diseases. This guide includes practical steps, interpretation guidelines, and documentation requirements.

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Comprehensive Guide to Office Spirometry for Respiratory Assessment

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  1. Office Spirometry Maria V. Gibson, MD, PhD

  2. Office spirometry indications Risk stratification, Evaluating disability , Occupational exposure >45 years old current or former smokers, Symptoms: prolongedcough, dyspnea, wheezing Assessing severity or progression of Asthma ,COPD, Sarcoidosis, pulmonary fibrosis, multiple sclerosis Am J Respir Crit Care Med , 2001, Jama 1997

  3. Contraindications for spirometry • Acute disorders affecting test performance (e.g., vomiting, nausea, vertigo) • Hemoptysis of unknown origin • Pneumothorax • Recent abdominal or thoracic surgery • Recent eye surgery • Recent myocardial infarction or unstable angina • Thoracic aneurysms

  4. Other benefits of procedure • Easy to perform, noninvasive • Performed by the trained staff • Time to read the test < 3 min • Increasing number of patients needed this test

  5. Coding • 94010 : 1.04 RVU • Spirometry, graphic record, total and timed vital capacity, expiratory flow rate measurement, with or without maximal voluntary ventilation • 94060: 1.79 RVU • Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration

  6. Coding • 47 yo male smoker came in to f/u persistent cough. You performed spirometry with bronchodilator • E/M code 99214 • Modifier 25, 94060 • ICD code: • Chronic bronchitis • PFTs with bronchodilator • Documentation: • Note for the visit: template ( chronic bronchitis) • In the Plan: procedure note with VEV1, FVC and FEV1/FVC documentation • Copy of the report scanned in special note studies

  7. Reimbursement • Reimbursement ( 94010, 94060) • Medicare $35.21 /$70 • Medicaid $37.49/$74 • BC/BS $74.00/ $148

  8. Earning potential for office spirometry at DFM+ UFM $6,256 118 445 $14,880

  9. Equipment IQmark digital Spirometer Recommended for adults only Provides Pre and post- bronchodilator testing

  10. Spirometry techinques • Step1: Equipment calibration • Step 2: enter correct weight, height , gender • Step 3: Coaching patient • Step 4: Check for adequacy

  11. Terminology • FEV1 • Volume of gas exhaled in 1 sec during performance of FVC • Forced Vital Capacity (FVC) • the total volume of air that can be exhaled during a maximal forced expiration effort • FEF25-75% • maximal midexpiratory flow • FEV1/FVC %ratio— • The percentage of the FVC expired in one second. (FEV1 /FVC × 100)

  12. a healthy person (B) severe obstruction (emphysema), • (C) severe restriction from interstitial disease (radiation fibrosis), (D) upper airways obstruction (tracheal stenosis), • E) poor effort.

  13. Spirometry interpretation

  14. How to check validity?

  15. How to determine ventilatory pattern?

  16. How to determine severity ?

  17. Bronchodilator challenge test response • FVC increase 200mL or • FEV1 increase 12% or • FEF 25-75% increase15- 25% • “ Improved after bronchodilation” • “Reversible airway disease”

  18. Documentation • 1.Progress note • Indication • Patient effort • Assessment • 2. Scanned original report in Special Studies

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