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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical/Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.19 Respiratory Services : 4.2.19.3 Pulmonary Function Studies

4.2.19.3
Pulmonary Function Studies
Pulmonary function studies considered for reimbursement to outpatient hospitals include, but are not limited to, the following procedures when submitted with the total component (TOS 5):
Procedure codes 94452 and 94453 must be submitted with one of the following diagnosis codes. Additionally, evidence of hypoxemia must be documented in the client’s medical record.
When multiple procedure codes are submitted, the most inclusive code of the related codes will be reimbursed and all other related codes will be denied.
The procedure codes listed in these tables are subject to National Correct Coding Initiative (NCCI) relationships. Providers should refer to the TMHP website at www.tmhp.com for NCCI correct coding guidelines and specific applicable code combinations.
When unrelated pulmonary function studies are submitted together, each will be considered for reimbursement.

Texas Medicaid & Healthcare Partnership
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