Health Information Management

Q/A: May we create a protocol for complete pulmonary function test?

APCs Insider, October 28, 2011

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Q: Some physicians send patients to our hospital outpatient department with an order for “complete PFT [pulmonary function test].” Does a standard definition describe a complete PFT? If none exists, may we develop a protocol for the tests that physicians order most frequently? Would notifying the physicians of such a protocol be sufficient? They certainly may order other tests their patients need.

A: PFT is a comprehensive term that describes a group of studies used to assess lung function. The exact type of tests required to assess an individual situation varies according to patients’ symptoms.

No single CPT® code provides a standard definition of a complete PFT. Development of an internal hospital-defined protocol appears to address the lack of consistency, but it won’t necessarily reflect the intent of ordering physicians who may not want these particular tests performed. CMS considers the expressed intent of physicians who order test(s); a hospital-defined protocol does not meet this requirement.

Ordering physicians should specify the tests to be performed to satisfy CMS’ requirement for individualized orders/care and to mitigate the risk of revenue reversal If your facility currently uses a preprinted order form and has already defined, add the components defined in the protocol to the order form. This shows that the physician readily knew what he or she was being and had the opportunity to add/subtract tests that were indicated for the patient.

Listing individual tests on preprinted order forms and allowing physicians to select those that are appropriate for individual scenarios is best practice.

Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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