Question:

Are there any limitations to pulmonary function studies that we should be aware of?

Answer:

Understand that it is expected that the provider follows a thoughtful, purposeful sequence in selecting tests and validates appropriateness for the patient’s presenting complaint, medical history, physical examination, and so on. For any item to be covered by Medicare, it must be eligible for a defined Medicare benefit category, be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and meet all other applicable Medicare statutory regulating requirements. Note that the Medicare program specifically excludes screening testing. Examples of screening also include, but are not limited to, the following:

  • An asymptomatic patient, with or without a high risk of lung disease
  • Studies as part of a routine exam
  • Studies as part of an epidemiological survey.
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