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Use of Spirometry Testing in the Assessment and Diagnosis of COPD

Advantage MD, EHP, Priority Partners, and USFHP

Measure evaluates the percentage of members 40 years of age and older with a new diagnosis of COPD or newly active COPD, who received appropriate spirometry testing to confirm diagnosis.

Best Practice and Measure Tips

  • At least one claim/encounter for spirometry during the 730 days (2 years) prior to the IESD through 180 days (6 months) after the IESD.
  • Members must have Negative Diagnosis History (no COPD diagnosis codes captured on claims) of 730 days (2 years) prior to the IESD to be included in the measure population.
  • Index Episode Start Date (IESD): The earliest date of service for an eligible visit (outpatient, ED, or acute inpatient) encounter during the Intake Period with any diagnosis of COPD.
  • Perform spirometry teston patients newly diagnosed with COPD within 180 days to confirm diagnosis of COPD, evaluate severity, and assess current therapy.If the patient had a spirometry performed in the previous 2 years to confirm the “new” diagnosis of COPD in the first place, they do not need a repeat.
  • Ensure appropriate documentation of spirometry testing.
  • Differentiate acute from chronic bronchitis and use correct code so that patient is not inadvertently put into the measure.
  • Review problem lists and encounter forms and remove COPD / chronic bronchitis when the diagnosis was made in error.
  • Do not bill the COPD diagnosis code when screening to rule out the condition; instead, use code Z13.83 (encounter for screening for respiratory disorder NEC).

Measure Exclusions

Required Exclusion: Hospice.

Measure Codes

  • Spirometry
    • 94010, 94014-94016, 94060, 94070, 94375, 94620
  • Outpatient CPT codes
    • 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99420, 99429, 99455, 99456
  • Outpatient HCPCS codes
    • G0402, G0438, G0439, G0463, T1015
  • ED
    • 99281-99285
  • Observation
    • 99217-99220
  • Codes for COPD
    • Chronic Bronchitis J41.0, J41.1, J41.8, J42
    • Emphysema J43.0, J43.1, J43.2, J43.8, J43.9
    • COPD J44.0, J44.1, J44.9
  • Encounter for screening for respiratory disorder
    • NEC Z13.83