- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Pulmonology Medical Billing & Credentialing — Built for Lung, Sleep & Critical Care Practices
Pulmonology medical billing sits at the intersection of some of the toughest coding territory in medicine — PFT bundling edits, 26/TC component splits, bronchoscopy code families with multiple-endoscopy rules, sleep study medical-necessity policies, and payer automation that auto-denies same-day E/M visits.
Pro Health Care Advisors delivers end-to-end pulmonology medical billing and credentialing built for lung health practices, sleep medicine centers, interventional programs, and critical care groups — focused on PFT & Procedure Coding Accuracy, Modifier 25 Defense, and Net Realized Revenue Growth.
Why Practices Trust Our Pulmonology Medical Billing Expertise
Generic billing vendors treat pulmonology like routine office billing. It isn't. A single patient can generate a PFT panel with NCCI bundling edits, a bronchoscopy with multiple-endoscopy payment math, a sleep study with payer-specific accreditation rules, and critical care time the next week. Our team is trained on exactly these moving parts, using AAPC-certified coding standards on every claim.
PFT Coding & Bundling Mastery
Spirometry (94010), bronchodilator responsiveness (94060), lung volumes (94726/94727), and DLCO (94729) carry NCCI edits that silently swallow revenue when billed together incorrectly.
We apply the correct code combinations, units, and 26/TC component logic per site of service — hospital-based professional-only vs. office-lab global — so every test pays at its correct rate.
Bronchoscopy & Interventional Coding
The 31622–31661 family — BAL, transbronchial biopsy, EBUS (31652–31654), navigational bronchoscopy — follows multiple-endoscopy payment rules that generic coders routinely get wrong. We sequence and modifier every scope claim correctly.
Sleep Medicine Compliance
In-lab PSG (95810/95811), home sleep tests, split-night rules, and payer accreditation requirements (AASM) — we manage the prior-auth and documentation chain that keeps sleep revenue payable.
Modifier 25 Denial Defense
Payer automation now auto-flags same-day E/M with routine PFTs. We build documentation standards and pre-submission edits that defend legitimate modifier 25 claims — instead of losing them or inviting audits.
RPM, CCM & Pulmonary Rehab Capture
Short-duration RPM codes, COPD chronic care management, and pulmonary rehabilitation (94625/94626) per Medicare's PR coverage rules — recurring revenue most practices leave uncollected.
Dedicated Pulmonology Account Team
A named Account Manager plus pulmonology-trained specialists — not a generic call center. A team that knows your test mix, your procedure volume, and your payer policies.
Pulmonology Medical Billing Across the Full Code Spectrum
From PFT panels and bronchoscopy families to sleep studies, critical care time, and pulmonary rehabilitation sessions — our AAPC-certified coders handle the complete respiratory claim spectrum, with CodeMAXX coding review on every high-dollar claim.
9 Comprehensive Pulmonology Medical Billing & Credentialing Services
Standard vendors process claims. We engineer respiratory revenue integrity. Practices searching for dependable pulmonology billing services get the complete stack in one engagement — PFT bundling validation, modifier 25 defense, and sleep compliance included as standard, not as add-ons.
Charge Capture & EHR Integration
Direct integration with your EHR and PFT/sleep lab systems through our EMR/EHR software service — eliminating manual entry errors before claims reach the clearinghouse.
PFT & Procedure Coding Review
Certified coders validate PFT combinations, bronchoscopy sequencing, and ICD-10 specificity (COPD J44.x, asthma J45.x, OSA G47.33). Our CodeMAXX service audits every high-dollar claim before submission.
Prior Auth & Sleep Study Workflows
We manage payer-specific prior authorization for in-lab studies, titrations, biologics, and advanced imaging — including home-sleep-test-first policies that trip up front desks daily.
Claims Submission & NCCI Scrubbing
Pulmonology-specific scrubbing covers PFT bundling edits, multiple-endoscopy rules, 26/TC placement, and modifier 25 documentation flags across every payer.
Denial Management & Medicare Appeals
We eliminate repeat denials — medical necessity on sleep studies, E/M bundling, component conflicts — and file appeals through all five levels per the CMS Medicare appeals process.
Payment Posting & Variance Detection
Automated remittance processing with contracted-rate variance flagging. When a payer underpays a component split or downcodes a bronchoscopy, we catch it and dispute it formally.
Accounts Receivable Follow-Up
Our pulmonology medical billing recovery team pursues revenue most practices assume is permanently lost — averaging 60–75% recovery on written-off AR.
Pulmonologist Credentialing & Enrollment
Our credentialing team manages CAQH, payer enrollment, interventional privileges verification (EBUS, robotic bronchoscopy), sleep lab accreditation alignment, and monthly OIG/SAM sweeps.
Pulmonology RCM Analytics & Reporting
Days in AR, denial rate by test category, modifier 25 win rate, and payer-specific performance — part of our full medical billing and practice management platform.
Your Practice's Revenue Cycle Is Leaking. We'll Show You Where.
Most pulmonology practices lose 8–12% of potential revenue to PFT bundling edits, auto-denied same-day E/M visits, and aging AR write-offs. Get a complimentary Pulmonology Payer Performance Audit — benchmarking your current pulmonology medical billing performance with zero obligation.
No sales pitch. No obligations. Just data.
Pulmonology Medical Billing for Every Practice Model
Each model bills differently — office-lab global PFTs vs. hospital professional components, sleep center accreditation rules vs. critical care time documentation. We staff for all of them, with pulmonology medical billing workflows tuned to each model's claim mix.
Private Pulmonology Practices
Office-based PFT labs billed globally, E/M optimization with modifier 25 defense, smoking cessation (99406/99407), and COPD chronic care management programs that add recurring revenue.
Sleep Medicine Centers
In-lab PSG and titration billing, home sleep test programs, split-night rules, AASM accreditation tracking, and the payer-specific medical-necessity chains that keep sleep claims payable.
Interventional Pulmonology Programs
EBUS, navigational and robotic bronchoscopy, stent placement, and thermoplasty — multiple-endoscopy payment math, device documentation, and advanced-privilege credentialing handled end to end.
Critical Care & ICU Groups
Time-based critical care billing (99291/99292), bundled-service rules, ventilator management, and split/shared visit documentation for hospital-based pulmonary intensivists.
Pulmonary Rehabilitation Programs
Session-based 94625/94626 billing, COPD GOLD-class and post-COVID eligibility documentation, supervising-practitioner rules, and the 36-to-72 lifetime session limits that require careful tracking.
Multi-Site Lung Health Groups
Unified AR reporting across office, hospital, and sleep lab locations — with site-of-service component logic and per-location tracking that keeps growing pulmonology medical billing operations audit-ready.
High-Impact Pulmonology Medical Billing Items We Manage Daily
These claim elements drive the majority of pulmonology medical billing revenue — and the majority of denials. Bundling math, component splits, and documentation chains are where our team earns its keep.
| Claim Element | Category | Common Denial / Loss Trigger | Our Safeguard | Status |
|---|---|---|---|---|
| 94010 + 94060 PFTs | Pulmonary function testing | NCCI bundling — spirometry inside responsiveness testing | Panel-level code selection rules pre-submission | ✓ Covered |
| 26 / TC components | Site-of-service splits | Global billed in hospital setting (or PC missed) | Per-payer site-of-service logic on every test | ✓ Covered |
| E/M + Modifier 25 | Same-day visits | Payer automation auto-denying visit with PFT | Documentation standards + pre-bill flag review | ✓ Covered |
| Sleep studies 95810/95811 | Sleep medicine | Medical necessity & HST-first policy denials | Prior-auth chain + accreditation tracking | ✓ Covered |
| Bronchoscopy 31622–31661 | Procedures | Multiple-endoscopy rule mis-sequencing | Family-based sequencing & modifier automation | ✓ Covered |
| RPM duration codes | Remote monitoring | Wrong code family for 2–15 day vs. 16+ day data | Duration-mapped code selection per program | ✓ Covered |
| Pulm rehab 94625/94626 | Rehabilitation programs | Session limits & eligibility documentation gaps | Lifetime-session tracking + eligibility templates | ✓ Covered |
Getting Started with Pulmonology Medical Billing: Our 5-Step Onboarding
From your first free practice assessment through full revenue cycle management — onboarding takes less than two weeks.
Free Practice AR Assessment
We analyze your pulmonology medical billing performance, PFT bundling exposure, modifier 25 denial patterns, and payer mix.
Credentialing & Privileges Audit
We verify CAQH profiles, payer enrollments, interventional privileges, and sleep accreditation alignment — catching gaps before they delay reimbursement.
EHR & Lab System Integration
We connect to your EHR, PFT lab, and sleep systems — Epic, athenahealth, eClinicalWorks, and more — no migration required.
Active Billing & Compliance
Certified coders manage claims from test to payment posting with continuous bundling, component, and documentation monitoring.
Monthly Practice Reporting
Real-time dashboards plus monthly optimization recommendations for your pulmonology medical billing performance.
Built-In RAC Audit Defense for Every Pulmonology Medical Billing Client
Respiratory claims draw heavy federal scrutiny — modifier 25 patterns and sleep study necessity sit on active RAC work plans. Every pulmonology client receives our MD Audit Shield program — proactive audit prevention and full federal audit defense at no extra charge.
Proactive — Not Reactive
PFT combinations, component splits, and modifier 25 documentation are validated continuously — not reconstructed under audit pressure after an overpayment demand arrives.
AAPC-Certified Coding Accuracy
Certified coders validate every CPT selection, ICD-10 specificity level, and modifier — eliminating the bundling triggers that put practices on RAC lists.
All 5 Medicare Appeal Levels
From Redetermination through Federal District Court — pulmonology-specific documentation packets at every level of the CMS appeals process.
HIPAA-Compliant Workflows
AES-256 encrypted document handling and BAA management built into every billing and audit workflow — practice and patient data stay protected.
Real-Time Compliance Reporting
Live dashboards showing your practice's audit risk profile, open appeals, and claim compliance metrics at all times.
Dedicated Audit Response Team
A named specialist manages your practice's account — not a call center. You always know who is handling your defense.
Pulmonology Medical Billing — Frequently Asked Questions
The 2026 CPT update added remote physiologic monitoring codes for data collected over 2–15 days in a month, removing the old 16-day minimum for those scenarios.
Our pulmonology medical billing team maps each monitoring program to the correct duration-based code family, so short-term pulse oximetry and peak-flow monitoring revenue is captured instead of written off.
Payer automation now routinely flags office visits billed alongside routine PFTs like spirometry. A separate E/M is payable only when documentation supports a significant, separately identifiable service, reported with modifier 25.
We build documentation standards and pre-submission edits that defend legitimate same-day E/M revenue while filtering claims that would trigger audits.
Yes. PFTs performed in hospital settings are typically billed professional-component-only with modifier 26, while office-based labs bill globally.
Site-of-service and component logic per payer is one of the most common pulmonology medical billing failure points — we validate it on every claim before submission.
Yes. Payers increasingly verify advanced-procedure qualifications separately for interventional pulmonology services such as EBUS and robotic or navigational bronchoscopy.
Our credentialing team manages fellowship verification, facility privileges alignment, and payer enrollment — so new interventionalists start generating revenue as soon as they finish training.
Many payers require lab accreditation (such as AASM) for polysomnography billing, enforce home-sleep-test-first policies, and apply strict medical-necessity criteria to in-lab studies and titrations.
We track accreditation status, prior authorization, and documentation requirements — so sleep revenue survives both pre-payment review and post-payment audit.
Explore More Medical Billing & Credentialing Resources
Pulmonology medical billing is one of 30+ specialties we serve nationwide.
Cardiology Medical Billing & Credentialing
Cardiopulmonary care overlaps constantly — shared patients, stress testing, and the same 26/TC component logic across diagnostic testing.
Cardiology Billing →Hospitalist Billing & Credentialing
Pulmonary intensivists and hospitalists share the ICU — critical care time, split/shared visits, and facility-based billing done right.
Hospitalist Billing →Physician Credentialing Services
Full-lifecycle credentialing — CAQH management, payer enrollment, interventional privileges verification, and OIG/SAM exclusion monitoring.
Credentialing Services →30+ Medical Billing Specialties We Serve
From mental health and pathology to pharmacy and home healthcare — explore every specialty-specific billing program we offer.
View All Specialties →